| NPI | 1710773551 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: FL PY11619) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: MD 06511) |
| 103TC2200X Psychologist, Clinical Child & Adolescent | |
| 103TS0200X Psychologist, School | |
| Enumeration Date | 2025-04-17 |
| Last Update Date | 2025-08-12 |