| NPI | 1811946908 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist |
| Additional Taxonomies | 103T00000X Psychologist (Licence: FL PY3449) |
| 103TC2200X Psychologist, Clinical Child & Adolescent | |
| 103TF0200X Psychologist, Forensic | |
| Enumeration Date | 2006-05-08 |
| Last Update Date | 2024-03-16 |