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 |