| NPI | 1588226575 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: FL 10492) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: FL PY10492) |
| Enumeration Date | 2019-07-01 |
| Last Update Date | 2025-04-14 |