| NPI | 1578876322 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: FL PY8892) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: FL MH 10214) |
| Enumeration Date | 2010-07-22 |
| Last Update Date | 2018-08-27 |