| NPI | 1023535549 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: TX 37652) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: TX 37652) |
| Enumeration Date | 2017-08-25 |
| Last Update Date | 2022-01-26 |