| NPI | 1235404179 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: FL PY5007) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: FL PY5007) |
| 103TF0200X Psychologist, Forensic (Licence: FL PY5007) | |
| Enumeration Date | 2012-03-11 |
| Last Update Date | 2023-06-16 |