| NPI | 1730395294 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CT 002761) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NY 016754) |
| 103TC0700X Psychologist, Clinical (Licence: RI PS00963) | |
| Enumeration Date | 2007-05-14 |
| Last Update Date | 2007-07-08 |