| NPI | 1437202074 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: FL PY8709) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: MD 3865) |
| Enumeration Date | 2007-01-18 |
| Last Update Date | 2018-12-07 |