| NPI | 1053678185 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: FL PY11492) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: PR 2537) |
| Enumeration Date | 2012-04-13 |
| Last Update Date | 2025-04-24 |