| NPI | 1518078351 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: FL PY11422) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: IL 071-004534) |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2022-06-28 |