| NPI | 1003142167 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: FL PY7997) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: FL 21733) |
| 103TC0700X Psychologist, Clinical (Licence: VA 0810008226) | |
| Enumeration Date | 2009-10-26 |
| Last Update Date | 2026-06-10 |