| NPI | 1912938622 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: FL PY9032) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: TN P0000002020) |
| Enumeration Date | 2006-07-05 |
| Last Update Date | 2020-06-29 |