| NPI | 1972657153 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: FL PY7164) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: FL PY 7164) |
| Enumeration Date | 2007-01-23 |
| Last Update Date | 2019-07-29 |