| NPI | 1700954427 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: NH 244) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: RI PS00226) |
| Enumeration Date | 2006-12-01 |
| Last Update Date | 2011-09-27 |