| NPI | 1134129307 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: FL PY2560) |
| Additional Taxonomies | 103TH0100X Psychologist, Health Service (Licence: FL PY2560) |
| Enumeration Date | 2005-07-28 |
| Last Update Date | 2007-08-09 |