| NPI | 1639393986 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: FL PY 5105) |
| Additional Taxonomies | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: FL PY 5105) |
| 103TF0000X Psychologist, Family (Licence: FL PY 5105) | |
| 103TF0200X Psychologist, Forensic (Licence: FL PY 5105) | |
| 103TP2701X Psychologist, Group Psychotherapy (Licence: FL PY 5105) | |
| Enumeration Date | 2007-04-11 |
| Last Update Date | 2007-07-08 |