| NPI | 1366486102 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JESSICA L DOMINGOS Credentialing Specialist 401-443-5122 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology |
| Enumeration Date | 2006-06-15 |
| Last Update Date | 2025-05-22 |