| NPI | 1306919840 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: TX 33718) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: CA PSY19797) |
| 103TC0700X Psychologist, Clinical (Licence: TX 33718) | |
| Enumeration Date | 2006-11-15 |
| Last Update Date | 2022-11-01 |