| NPI | 1043803687 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: UT 13436105-2501) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: OK 1376) |
| 103TC0700X Psychologist, Clinical (Licence: ND 660) | |
| Enumeration Date | 2021-02-15 |
| Last Update Date | 2025-10-29 |