| NPI | 1699067348 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TS0200X Psychologist, School (Licence: FL psy290 retired) |
| Additional Taxonomies | 174400000X Specialist (Licence: FL psy290 retired) |
| Enumeration Date | 2011-05-12 |
| Last Update Date | 2011-05-12 |