| NPI | 1427681469 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: TX 38473) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: FL 10683) |
| Enumeration Date | 2020-02-18 |
| Last Update Date | 2020-03-30 |