| NPI | 1003472200 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: RI PS02024) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: MD 06567) |
| Enumeration Date | 2019-05-13 |
| Last Update Date | 2021-12-22 |