| NPI | 1952891624 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: RI PS01912) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: NE 11459) |
| Enumeration Date | 2018-05-17 |
| Last Update Date | 2020-11-16 |