| NPI | 1346772589 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: FL PY11285) |
| Additional Taxonomies | 103T00000X Psychologist |
| 101YM0800X Counselor, Mental Health | |
| 103TC0700X Psychologist, Clinical (Licence: GA PSY004688) | |
| Enumeration Date | 2017-03-28 |
| Last Update Date | 2026-05-11 |