| NPI | 1205844271 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: TX 22649) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: TX 2-2649) |
| Enumeration Date | 2006-08-04 |
| Last Update Date | 2020-05-07 |