| NPI | 1528205556 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: RI PS01128) |
| Additional Taxonomies | 103TA0400X Psychologist, Addiction (Substance Use Disorder) (Licence: RI PS01128) |
| Enumeration Date | 2009-01-13 |
| Last Update Date | 2012-10-15 |