| NPI | 1114544533 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: RI PS02118) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: MA PSY10000589) |
| Enumeration Date | 2020-07-01 |
| Last Update Date | 2024-02-10 |