| NPI | 1255540977 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: UT 7634974-2501) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: WY 443) |
| Enumeration Date | 2007-05-21 |
| Last Update Date | 2016-11-03 |