| NPI | 1467408542 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: TX 36694) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: NY 009654) |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: TX 36694) | |
| Enumeration Date | 2006-05-26 |
| Last Update Date | 2017-01-16 |