| NPI | 1538559265 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: FL PY5807) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: FL PY0005807) |
| Enumeration Date | 2015-02-03 |
| Last Update Date | 2019-04-19 |