| NPI | 1801906946 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: FL PY 5244) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: MA 2021) |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2014-01-16 |