| NPI | 1013585116 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: RI PS01956) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: MA PSY10001156) |
| Enumeration Date | 2021-06-15 |
| Last Update Date | 2025-10-01 |