| NPI | 1396762118 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: UT 1089502501) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: UT 1089503501) |
| Enumeration Date | 2006-07-16 |
| Last Update Date | 2007-07-08 |