| NPI | 1285750083 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: FL PY 7340) |
| Additional Taxonomies | 103TP2701X Psychologist Group Psychotherapy (Licence: FL PY 7340) |
| Enumeration Date | 2007-03-22 |
| Last Update Date | 2022-05-06 |