| NPI | 1225464423 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: FL PY9171) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: FL PPY182) |
| Enumeration Date | 2013-09-19 |
| Last Update Date | 2020-04-20 |