| NPI | 1700217429 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: FL PY8782) |
| Additional Taxonomies | 103K00000X Behavior Analyst (Licence: FL PY8782) |
| 103TC1900X Psychologist, Counseling (Licence: FL PY8782) | |
| Enumeration Date | 2013-12-05 |
| Last Update Date | 2023-08-31 |