| NPI | 1629451588 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MA 11457) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: RI PS01612) |
| 103T00000X Psychologist (Licence: WI 3489) | |
| Enumeration Date | 2015-07-09 |
| Last Update Date | 2023-08-25 |