| NPI | 1417985821 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: FL PY10065) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: KY KY-1144) |
| Enumeration Date | 2006-06-28 |
| Last Update Date | 2019-02-20 |