| NPI | 1255397626 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: FL PY 5282) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: VA 0810001484) |
| Enumeration Date | 2006-04-25 |
| Last Update Date | 2010-11-16 |