| NPI | 1689681561 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: FL PY3156) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: FL PY3156) |
| Enumeration Date | 2006-08-02 |
| Last Update Date | 2018-12-27 |