| NPI | 1750307427 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: FL PY10893) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: MD 03845) |
| Enumeration Date | 2006-07-14 |
| Last Update Date | 2026-03-04 |