| NPI | 1386159705 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: TX 37699) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: MO 2017042123) |
| Enumeration Date | 2017-12-07 |
| Last Update Date | 2023-03-11 |