| NPI | 1356476782 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: FL PY9814) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical |
| Enumeration Date | 2007-02-23 |
| Last Update Date | 2022-06-22 |