| NPI | 1831181817 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: FL PY 5233) |
| Additional Taxonomies | 103TF0200X Psychologist, Forensic (Licence: FL PY 5233) |
| 103TH0100X Psychologist, Health Service (Licence: FL PY 5233) | |
| Enumeration Date | 2005-08-17 |
| Last Update Date | 2013-02-16 |