| NPI | 1801136437 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: FL PY10859) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: NY 023585) |
| Enumeration Date | 2013-02-19 |
| Last Update Date | 2023-02-07 |