| NPI | 1386283810 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: TX 41046) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: WI 3698-57) |
| Enumeration Date | 2020-01-01 |
| Last Update Date | 2026-03-08 |