| NPI | 1780928556 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: FL PY8744) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: GA PSY003599) |
| Enumeration Date | 2012-11-19 |
| Last Update Date | 2018-03-17 |