| NPI | 1104854041 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: FL PY7771) |
| Additional Taxonomies | 104100000X Social Worker (Licence: KY 2005-64) |
| Enumeration Date | 2006-06-29 |
| Last Update Date | 2009-02-04 |