| NPI | 1033960794 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: RI PS02316) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist |
| Enumeration Date | 2024-04-01 |
| Last Update Date | 2024-12-11 |