| NPI | 1972539690 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: FL PY 4331) |
| Additional Taxonomies | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: FL PY 4331) |
| Enumeration Date | 2006-06-24 |
| Last Update Date | 2017-08-23 |