| NPI | 1932509882 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TH0100X Psychologist, Health Service (Licence: MA 10630) |
| Additional Taxonomies | 101Y00000X Counselor |
| 103TC0700X Psychologist, Clinical (Licence: RI PS01650) | |
| 103TH0100X Psychologist, Health Service (Licence: RI PS01650) | |
| Enumeration Date | 2014-08-28 |
| Last Update Date | 2023-11-13 |