| NPI | 1982918819 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: RI PS01393) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: NE 9188) |
| Enumeration Date | 2010-08-03 |
| Last Update Date | 2025-03-11 |