| NPI | 1700013117 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: FL PY 6052) |
| Additional Taxonomies | 101YP1600X Counselor, Pastoral (Licence: FL PY 6052) |
| 103TC0700X Psychologist, Clinical (Licence: FL PY6052) | |
| 103TC1900X Psychologist, Counseling (Licence: FL PY 6052) | |
| Enumeration Date | 2009-06-12 |
| Last Update Date | 2009-06-12 |