| NPI | 1356539837 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TA0700X Psychologist, Adult Development & Aging |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: FL PSY7593) |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: FL 7593) | |
| Enumeration Date | 2007-10-09 |
| Last Update Date | 2023-11-17 |