| NPI | 1144299819 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: TX 21340) |
| Additional Taxonomies | 103TH0100X Psychologist, Health Service (Licence: TX 21340) |
| 103TR0400X Psychologist, Rehabilitation (Licence: TX 21340) | |
| Enumeration Date | 2006-03-15 |
| Last Update Date | 2012-07-26 |