| NPI | 1487236097 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: RI PS01955) |
| Additional Taxonomies | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: FL PY10666) |
| Enumeration Date | 2021-04-22 |
| Last Update Date | 2021-08-31 |