| NPI | 1609904127 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: FL PY 8349) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: MI 6301008213) |
| Enumeration Date | 2007-02-28 |
| Last Update Date | 2015-04-14 |