| NPI | 1922292887 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: FL PY9268) |
| Additional Taxonomies | 103TS0200X Psychologist, School (Licence: FL PY9268) |
| Enumeration Date | 2007-09-04 |
| Last Update Date | 2018-01-18 |