| NPI | 1841909223 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: FL PY9895) |
| Additional Taxonomies | 103TB0200X Psychologist, Cognitive & Behavioral |
| 103TH0004X Psychologist, Health | |
| 103TH0100X Psychologist, Health Service | |
| Enumeration Date | 2022-11-15 |
| Last Update Date | 2023-01-03 |