| NPI | 1033308747 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: TX 35037) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: GA PSY002678) |
| Enumeration Date | 2007-10-18 |
| Last Update Date | 2026-07-14 |