| NPI | 1982731873 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: FL 7118) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: FL PY7118) |
| Enumeration Date | 2007-02-27 |
| Last Update Date | 2025-03-05 |