| NPI | 1063422772 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: FL PY3369) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: FL PY3369) |
| 103TF0200X Psychologist, Forensic (Licence: FL PY3369) | |
| Enumeration Date | 2006-08-08 |
| Last Update Date | 2012-09-19 |