| NPI | 1841416260 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: FL PY7427) |
| Additional Taxonomies | 103TF0200X Psychologist, Forensic (Licence: FL PY7427) |
| 103TH0100X Psychologist, Health Service (Licence: FL PY7427) | |
| 103TH0004X Psychologist, Health (Licence: FL PY7427) | |
| 103TC0700X Psychologist, Clinical (Licence: GA PSY003115) | |
| 103TF0200X Psychologist, Forensic (Licence: GA PSY003115) | |
| 103TH0004X Psychologist, Health (Licence: GA PSY003115) | |
| 103TH0100X Psychologist, Health Service (Licence: GA PSY003115) | |
| Enumeration Date | 2007-04-17 |
| Last Update Date | 2007-08-27 |