| NPI | 1770778714 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: TX 37124) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: RI PS01337) |
| 103TC0700X Psychologist, Clinical (Licence: MA 9702) | |
| Enumeration Date | 2007-09-12 |
| Last Update Date | 2018-03-17 |