| NPI | 1578515912 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: FL PY6364) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: FL AP1917) |
| Enumeration Date | 2006-05-16 |
| Last Update Date | 2012-08-08 |