| NPI | 1013084672 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: FL PY6222) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: CT 0002317) |
| Enumeration Date | 2006-11-29 |
| Last Update Date | 2018-09-14 |