| NPI | 1699081943 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: FL PY8480) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: IL 071007964) |
| Enumeration Date | 2010-08-25 |
| Last Update Date | 2022-07-21 |