| NPI | 1013941244 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: FL py6420) |
| Additional Taxonomies | 103TH0100X Psychologist, Health Service (Licence: FL py6420) |
| Enumeration Date | 2006-07-11 |
| Last Update Date | 2020-09-21 |