| NPI | 1801955547 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: RI PS01761) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: RI PS01761) |
| Enumeration Date | 2006-12-08 |
| Last Update Date | 2022-03-31 |