| NPI | 1265326938 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: FL PY12710) |
| Additional Taxonomies | 103TM1800X Psychologist, Intellectual & Developmental Disabilities |
| 103TB0200X Psychologist, Cognitive & Behavioral | |
| 103TC1900X Psychologist, Counseling | |
| 103TH0004X Psychologist, Health | |
| Enumeration Date | 2025-06-05 |
| Last Update Date | 2025-06-05 |