| NPI | 1376556878 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: FL PY6322) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: FL PY6322) |
| 103TA0700X Psychologist, Adult Development & Aging (Licence: FL PY6322) | |
| 103TB0200X Psychologist, Cognitive & Behavioral (Licence: FL PY6322) | |
| 103TC1900X Psychologist, Counseling (Licence: FL PY6322) | |
| 103TE1100X Psychologist, Exercise & Sports (Licence: FL PY6322) | |
| 103TH0100X Psychologist, Health Service (Licence: FL PY6322) | |
| 103TP0814X Psychologist, Psychoanalysis (Licence: FL PY6322) | |
| Enumeration Date | 2006-08-14 |
| Last Update Date | 2017-03-04 |