| NPI | 1033532536 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: FL PY 8957) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: FL PY8957) |
| Enumeration Date | 2014-02-04 |
| Last Update Date | 2020-09-22 |