| NPI | 1972605483 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: FL PY11342) |
| Additional Taxonomies | 103K00000X Behavior Analyst (Licence: FL 1-22-59221) |
| 106H00000X Marriage & Family Therapist (Licence: FL MT 2528) | |
| Enumeration Date | 2006-09-04 |
| Last Update Date | 2026-04-21 |