| NPI | 1629441894 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: FL PY11384) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: FL PY11384) |
| 103T00000X Psychologist (Licence: FL PY11384) | |
| 103TC1900X Psychologist, Counseling (Licence: FL PY11384) | |
| Enumeration Date | 2015-11-10 |
| Last Update Date | 2024-02-19 |