| NPI | 1811042427 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: FL PY9879) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: KY 0510) |
| 103TC1900X Psychologist, Counseling (Licence: KY 165058) | |
| Enumeration Date | 2007-01-24 |
| Last Update Date | 2018-08-13 |