| NPI | 1710027099 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: ME 803) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: MA 4851) |
| 103TC0700X Psychologist, Clinical (Licence: RI 427) | |
| Enumeration Date | 2007-02-07 |
| Last Update Date | 2007-07-08 |