| NPI | 1821636382 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: RI PS01826) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: RI PS01826) |
| Enumeration Date | 2019-12-16 |
| Last Update Date | 2020-05-05 |