| NPI | 1205226529 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: FL PY10024) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: MO 2007011145) |
| Enumeration Date | 2015-01-24 |
| Last Update Date | 2018-03-17 |