| NPI | 1275774010 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: RI PS01064) |
| Additional Taxonomies | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: RI PS01064) |
| 103TF0000X Psychologist, Family (Licence: RI PS01064) | |
| Enumeration Date | 2009-03-06 |
| Last Update Date | 2009-03-06 |