| NPI | 1477726594 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: FL PY5927) |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: FL PY5927) | |
| 103TF0200X Psychologist, Forensic (Licence: FL PY5927) | |
| Enumeration Date | 2008-04-09 |
| Last Update Date | 2015-12-14 |