| NPI | 1831119551 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: FL PY2600) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: FL PY2600) |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: FL PY2600) | |
| 103TF0200X Psychologist, Forensic (Licence: FL PY2600) | |
| 106H00000X Marriage & Family Therapist (Licence: FL MF519) | |
| Enumeration Date | 2006-07-19 |
| Last Update Date | 2012-02-06 |