| NPI | 1326662685 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: TX 37727) |
| Additional Taxonomies | 103TH0004X Psychologist, Health |
| 103TH0100X Psychologist, Health Service | |
| Enumeration Date | 2020-06-02 |
| Last Update Date | 2020-06-02 |