| NPI | 1386775617 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: FL PY6632) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: FL PY6632) |
| 103T00000X Psychologist (Licence: NC 5348) | |
| 103T00000X Psychologist (Licence: CA 32975) | |
| Enumeration Date | 2007-03-08 |
| Last Update Date | 2026-04-02 |