| NPI | 1750051827 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: RI PS01992) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: MA 11768) |
| Enumeration Date | 2021-09-20 |
| Last Update Date | 2022-04-12 |