| NPI | 1033246962 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: TX 39086) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: CO PSY 3998) |
| Enumeration Date | 2007-02-27 |
| Last Update Date | 2023-07-20 |