| NPI | 1952583478 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: FL PY10115) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: GA 2961) |
| 103TC0700X Psychologist, Clinical (Licence: MS 54951) | |
| Enumeration Date | 2007-11-27 |
| Last Update Date | 2025-10-15 |