| NPI | 1770832271 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: RI 01392) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: RI PS01392) |
| 103T00000X Psychologist (Licence: RI 01392) | |
| 103TC0700X Psychologist, Clinical (Licence: RI PS01392) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2012-08-30 |
| Last Update Date | 2020-11-10 |