| NPI | 1639131360 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: RI PS00748) |
| Additional Taxonomies | 322D00000X Residential Treatment Facility, Emotionally Disturbed Children |
| 251S00000X (Licence: RI PS00748) | |
| Enumeration Date | 2006-04-06 |
| Last Update Date | 2008-02-20 |