| NPI | 1992900187 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: FL PY7493) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: NY 009779) |
| Enumeration Date | 2007-06-18 |
| Last Update Date | 2020-04-03 |