| NPI | 1629113568 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: FL PY2368) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: FL MT857) |
| Enumeration Date | 2007-02-20 |
| Last Update Date | 2011-10-06 |