| NPI | 1154725364 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: NM 1344) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: TX 39112) |
| Enumeration Date | 2014-10-17 |
| Last Update Date | 2024-04-15 |