| NPI | 1891919635 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: FL 9451) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NC 2085) |
| Enumeration Date | 2007-04-12 |
| Last Update Date | 2020-12-07 |