| NPI | 1235205634 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: TX 21567) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: TX 2 1567) |
| Enumeration Date | 2006-11-28 |
| Last Update Date | 2023-12-29 |