| NPI | 1285982314 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: FL PY8811) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: VA 0810-004749) |
| Enumeration Date | 2012-08-21 |
| Last Update Date | 2018-10-15 |