| NPI | 1841466950 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: FL PY12451) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: MD 04693) |
| Enumeration Date | 2008-05-08 |
| Last Update Date | 2025-04-01 |