NPI | 1942307657 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: RI PS000245) |
Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: MA 3113) |
Enumeration Date | 2006-09-17 |
Last Update Date | 2007-07-08 |