| NPI | 1699763789 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: FL PY5017) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: FL PY5017) |
| Enumeration Date | 2005-10-12 |
| Last Update Date | 2023-10-16 |