| NPI | 1255913554 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: FL PY11079) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: PR 3471) |
| 103TC0700X Psychologist, Clinical (Licence: FL 10901) | |
| Enumeration Date | 2021-04-26 |
| Last Update Date | 2021-04-26 |