| NPI | 1255391835 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TP2701X Psychologist, Group Psychotherapy (Licence: FL MH3131) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: FL MH3131) |
| Enumeration Date | 2006-03-27 |
| Last Update Date | 2009-12-24 |