| NPI | 1861645186 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: FL PY7747) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: FL PY7747) |
| Enumeration Date | 2008-10-30 |
| Last Update Date | 2012-06-08 |