| NPI | 1700170446 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: FL PY8156) |
| Additional Taxonomies | 103TB0200X Psychologist Cognitive & Behavioral (Licence: FL PY8156) |
| 103TC2200X Psychologist Clinical Child & Adolescent (Licence: FL PY8156) | |
| 103TF0000X Psychologist Family (Licence: FL PY8156) | |
| 103TF0200X Psychologist Forensic (Licence: FL PY8156) | |
| 103TP2701X Psychologist Group Psychotherapy (Licence: FL PY8156) | |
| Enumeration Date | 2011-05-29 |
| Last Update Date | 2011-05-29 |