| NPI | 1013347277 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: FL PY8916) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: FL PY8916) |
| Enumeration Date | 2013-11-25 |
| Last Update Date | 2018-12-07 |