| NPI | 1447340369 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: FL PY7187) |
| Additional Taxonomies | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: FL PY7187) |
| 103TH0100X Psychologist, Health Service (Licence: FL PY7187) | |
| Enumeration Date | 2006-10-13 |
| Last Update Date | 2011-08-24 |