| NPI | 1497972855 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: FL PY3680) |
| Additional Taxonomies | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: FL PY 3680) |
| 222Q00000X Developmental Therapist (Licence: FL PY3680) | |
| Enumeration Date | 2007-04-19 |
| Last Update Date | 2019-05-07 |