| NPI | 1043767197 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: TX 38873) |
| Additional Taxonomies | 103T00000X Psychologist |
| 103TC1900X Psychologist, Counseling | |
| 103TH0100X Psychologist, Health Service | |
| Enumeration Date | 2016-09-07 |
| Last Update Date | 2023-03-06 |