| NPI | 1487950887 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TS0200X Psychologist, School (Licence: FL ss1069) |
| Additional Taxonomies | 103TC1900X Psychologist, Counseling (Licence: FL ss1069) |
| Enumeration Date | 2011-02-01 |
| Last Update Date | 2014-08-26 |