| NPI | 1124464557 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TH0004X Psychologist, Health (Licence: FL PY 9076) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: FL PY 9076) |
| 103TC0700X Psychologist, Clinical (Licence: FL PY 9076) | |
| Enumeration Date | 2013-05-13 |
| Last Update Date | 2014-08-04 |