NPI | 1063585784 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: TX 30562) |
Additional Taxonomies | 103T00000X Psychologist (Licence: TX 30562) |
Enumeration Date | 2006-11-17 |
Last Update Date | 2018-06-19 |