| NPI | 1205319217 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: TX 36813) |
| Additional Taxonomies | 103TH0004X Psychologist, Health (Licence: TX 36813) |
| Enumeration Date | 2018-09-14 |
| Last Update Date | 2018-12-18 |