| NPI | 1275677643 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: TX 22630) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: TX 22630) |
| Enumeration Date | 2007-02-17 |
| Last Update Date | 2026-07-06 |