| NPI | 1134252794 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: RI PS00241) |
| Additional Taxonomies | 103TA0400X Psychologist, Addiction (Substance Use Disorder) (Licence: RI PS00241) |
| 103TC0700X Psychologist, Clinical (Licence: RI PS00241) | |
| Enumeration Date | 2007-03-13 |
| Last Update Date | 2024-05-16 |