| NPI | 1417105792 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: TN P0000002879) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: UT 326632-2501) |
| Enumeration Date | 2008-08-28 |
| Last Update Date | 2021-09-22 |