| NPI | 1356548853 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: FL PY 9536) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: FL PY 9536) |
| 103TA0700X Psychologist Adult Development & Aging (Licence: FL PY 9536) | |
| 103TB0200X Psychologist Cognitive & Behavioral (Licence: FL PY 9536) | |
| 103TF0000X Psychologist Family (Licence: FL PY 9536) | |
| 103TF0200X Psychologist Forensic (Licence: FL PY 9536) | |
| 103TH0100X Psychologist Health Service (Licence: FL PY 9536) | |
| Enumeration Date | 2007-06-28 |
| Last Update Date | 2022-01-31 |