| NPI | 1710106521 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: FL PY8338) |
| Additional Taxonomies | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: AL 475) |
| Enumeration Date | 2007-04-24 |
| Last Update Date | 2018-11-09 |