| NPI | 1952385940 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: FL PY8365) |
| Additional Taxonomies | 103TC1900X Psychologist, Counseling (Licence: TN 2316) |
| Enumeration Date | 2005-12-02 |
| Last Update Date | 2022-09-26 |