| NPI | 1568640548 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: FL PY7539) |
| Additional Taxonomies | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: FL PY7539) |
| 103TC0700X Psychologist, Clinical (Licence: FL PY7539) | |
| Enumeration Date | 2008-02-01 |
| Last Update Date | 2011-03-18 |