| NPI | 1003896705 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: FL PY 9208) |
| Additional Taxonomies | 103TC1900X Psychologist Counseling (Licence: NC 3122) |
| Enumeration Date | 2006-01-19 |
| Last Update Date | 2014-12-10 |