| NPI | 1366726770 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TS0200X Psychologist School (Licence: FL SS 674) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: FL SS674) |
| Enumeration Date | 2011-10-04 |
| Last Update Date | 2011-10-28 |