| NPI | 1790703973 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: FL PY6228) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: FL SW3802) |
| Enumeration Date | 2006-07-17 |
| Last Update Date | 2011-10-17 |