| NPI | 1811936073 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: FL PY7550) |
| Additional Taxonomies | 103TS0200X Psychologist, School (Licence: FL PY7550) |
| Enumeration Date | 2006-06-05 |
| Last Update Date | 2008-06-04 |