| NPI | 1174711824 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: TX 37817) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: FL PY7032) |
| Enumeration Date | 2007-10-09 |
| Last Update Date | 2024-01-22 |