| NPI | 1083171458 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: FL PY12212) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: FL MH16244) |
| 103TC0700X Psychologist, Clinical (Licence: FL PY12212) | |
| Enumeration Date | 2019-02-21 |
| Last Update Date | 2024-06-04 |