| NPI | 1154891380 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: FL PY10513) |
| Additional Taxonomies | 103TS0200X Psychologist, School (Licence: FL 1287) |
| Enumeration Date | 2018-11-30 |
| Last Update Date | 2023-01-23 |