| NPI | 1427275148 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TR0400X Psychologist Rehabilitation (Licence: FL PY6113) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: FL PY6113) |
| 103TH0004X Psychologist Health (Licence: FL PY6113) | |
| Enumeration Date | 2007-04-20 |
| Last Update Date | 2016-08-16 |