| NPI | 1649316167 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: FL PY0004136) |
| Additional Taxonomies | 103TA0700X Psychologist, Adult Development & Aging (Licence: FL PY0004136) |
| 103TC0700X Psychologist, Clinical (Licence: FL PY0004136) | |
| 103TH0100X Psychologist, Health Service (Licence: FL PY0004136) | |
| 103TR0400X Psychologist, Rehabilitation (Licence: FL PY0004136) | |
| Enumeration Date | 2007-01-30 |
| Last Update Date | 2017-03-30 |