| NPI | 1528278611 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: FL MH6241) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: FL PY6877) |
| 103TC0700X Psychologist, Clinical (Licence: FL PY6877) | |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: FL PY6877) | |
| 103TF0000X Psychologist, Family (Licence: FL PY6877) | |
| Enumeration Date | 2007-05-23 |
| Last Update Date | 2007-07-08 |