| NPI | 1154776557 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: FL PY7980) |
| Additional Taxonomies | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: FL PY7980) |
| 103TH0004X Psychologist, Health (Licence: FL PY7980) | |
| Enumeration Date | 2016-05-04 |
| Last Update Date | 2023-07-28 |