| NPI | 1841418456 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: FL PY 3938) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: FL AP 628) |
| Enumeration Date | 2007-04-22 |
| Last Update Date | 2017-03-20 |