| NPI | 1356726202 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: TX 39361) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NY 023820) |
| Enumeration Date | 2015-07-21 |
| Last Update Date | 2023-03-28 |