| NPI | 1528523420 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: FL PY11521) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: MO 2018027298) |
| Enumeration Date | 2019-02-05 |
| Last Update Date | 2022-09-12 |