| NPI | 1306095633 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: UT 8883397-2501) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: UT 8883397-2501) |
| Enumeration Date | 2008-09-10 |
| Last Update Date | 2021-10-16 |