| NPI | 1043892649 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: RI PS01135) |
| Additional Taxonomies | 103TC1900X Psychologist, Counseling (Licence: RI 001135) |
| Enumeration Date | 2021-04-22 |
| Last Update Date | 2021-08-27 |