| NPI | 1447366810 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: TX 22482) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: TX 8795) |
| 103T00000X Psychologist (Licence: TX 2-2482) | |
| Enumeration Date | 2006-08-21 |
| Last Update Date | 2020-06-03 |