| NPI | 1699942540 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: RI PS01089) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: MA 8865) |
| Enumeration Date | 2008-05-09 |
| Last Update Date | 2021-01-09 |