| NPI | 1881703817 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: FL PY7763) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: MA 8441) |
| 103T00000X Psychologist (Licence: FL PY7763) | |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2022-07-21 |