| NPI | 1881671386 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: FL PY0002507) |
| Additional Taxonomies | 103TS0200X Psychologist, School (Licence: FL SS33) |
| Enumeration Date | 2005-12-27 |
| Last Update Date | 2011-12-08 |