| NPI | 1528317203 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC1900X Psychologist, Counseling (Licence: FL PY8463) |
| Additional Taxonomies | 103TF0200X Psychologist, Forensic (Licence: FL PY8463) |
| Enumeration Date | 2012-09-10 |
| Last Update Date | 2022-06-17 |