| NPI | 1588688600 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: RI PS02231) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: CO 2806) |
| Enumeration Date | 2006-07-26 |
| Last Update Date | 2025-08-19 |