| NPI | 1124076237 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: FL PY8690) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: GA PSY003045) |
| Enumeration Date | 2006-05-04 |
| Last Update Date | 2013-04-26 |