| NPI | 1043211972 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: TX D5637) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: TX D5637) |
| Enumeration Date | 2005-08-02 |
| Last Update Date | 2020-03-12 |