| 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 |