| NPI | 1386136356 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: FL PY10936) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: MD 06054) |
| Enumeration Date | 2018-06-05 |
| Last Update Date | 2023-11-15 |