| NPI | 1306127139 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: FL PY9773) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: AR 13-22P) |
| 103T00000X Psychologist (Licence: FL PY9773) | |
| Enumeration Date | 2011-09-07 |
| Last Update Date | 2018-08-30 |