| NPI | 1578919973 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: FL PY9813) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: FL PPY203) |
| Enumeration Date | 2016-05-04 |
| Last Update Date | 2025-05-22 |