| NPI | 1669652012 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: RI PS01047) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: MA 8790) |
| Enumeration Date | 2007-11-13 |
| Last Update Date | 2009-03-09 |