| NPI | 1467443432 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: TX 25472) |
| Additional Taxonomies | 103TA0700X Psychologist, Adult Development & Aging (Licence: TX 25472) |
| Enumeration Date | 2005-10-31 |
| Last Update Date | 2016-08-02 |