| NPI | 1558548081 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: FL PY7669) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: FL MH6401) |
| 103TC0700X Psychologist, Clinical (Licence: CT 002577) | |
| Enumeration Date | 2008-01-28 |
| Last Update Date | 2016-07-25 |