| NPI | 1598190076 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: FL PY11543) |
| Additional Taxonomies | 103TC1900X Psychologist Counseling (Licence: CT 8.004015) |
| Enumeration Date | 2013-09-04 |
| Last Update Date | 2022-08-15 |