| NPI | 1952701088 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MA 11436) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: RI PS01457) |
| 103TB0200X Psychologist, Cognitive & Behavioral (Licence: RI PS01457) | |
| 103TC0700X Psychologist, Clinical (Licence: RI PS01457) | |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: RI PS01457) | |
| Enumeration Date | 2014-08-26 |
| Last Update Date | 2021-04-08 |