| NPI | 1598791410 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: FL PY 7278) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: OH 4827) |
| Enumeration Date | 2006-06-23 |
| Last Update Date | 2008-09-18 |