| NPI | 1588715973 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: FL PY5339) |
| Additional Taxonomies | 103TA0700X Psychologist, Adult Development & Aging (Licence: FL PY5339) |
| 103TH0100X Psychologist, Health Service (Licence: FL PY5339) | |
| 103T00000X Psychologist (Licence: FL PY5339) | |
| Enumeration Date | 2007-01-15 |
| Last Update Date | 2008-06-03 |