| NPI | 1417080078 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: FL PY11139) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: NC 2486) |
| 103T00000X Psychologist (Licence: SC 712) | |
| 103TC0700X Psychologist, Clinical (Licence: FL PY11139) | |
| Enumeration Date | 2007-03-13 |
| Last Update Date | 2024-08-20 |