| NPI | 1093884892 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: FL PY 2265) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: FL PY 2265) |
| 103TC1900X Psychologist, Counseling (Licence: FL PY 2265) | |
| Enumeration Date | 2006-11-07 |
| Last Update Date | 2009-01-06 |