| NPI | 1447317227 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: FL PY5474) |
| Additional Taxonomies | 103TC1900X Psychologist, Counseling (Licence: FL PY5474) |
| Enumeration Date | 2007-01-02 |
| Last Update Date | 2017-01-23 |