| NPI | 1871703942 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: FL PY6995) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: FL PY6995) |
| Enumeration Date | 2007-05-23 |
| Last Update Date | 2021-05-25 |