| NPI | 1891278669 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MA 10000604) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: NY 022843) |
| 103T00000X Psychologist (Licence: RI 002253) | |
| Enumeration Date | 2018-09-07 |
| Last Update Date | 2025-08-12 |