| NPI | 1942360342 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: VT 048.0074176) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: RI PSY671) |
| Enumeration Date | 2006-12-08 |
| Last Update Date | 2023-10-09 |