| NPI | 1417624008 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: TX 38361) |
| Additional Taxonomies | 103TF0200X Psychologist, Forensic (Licence: TX 38361) |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: TX 38361) | |
| Enumeration Date | 2021-08-23 |
| Last Update Date | 2021-08-23 |