| NPI | 1568646123 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: FL PY4977) |
| Additional Taxonomies | 103TB0200X Psychologist Cognitive & Behavioral (Licence: FL PY4977) |
| 103TF0000X Psychologist Family (Licence: FL PY4977) | |
| Enumeration Date | 2007-12-19 |
| Last Update Date | 2020-04-25 |