| NPI | 1790015741 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: FL PY8264) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: MO 2009038948) |
| Enumeration Date | 2010-01-13 |
| Last Update Date | 2022-11-03 |