| NPI | 1518144351 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: RI PS00501) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: FL PY 9226) |
| Enumeration Date | 2008-01-23 |
| Last Update Date | 2015-11-10 |