| NPI | 1215189204 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: FL PY7603) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: FL PY7603) |
| Enumeration Date | 2008-10-21 |
| Last Update Date | 2021-06-11 |