| NPI | 1790850246 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: FL PY11199) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: FL 11199) |
| Enumeration Date | 2006-11-21 |
| Last Update Date | 2021-11-24 |