| NPI | 1508267881 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: UT 11991237-2501) |
| Additional Taxonomies | 1041S0200X Social Worker, School |
| Enumeration Date | 2014-09-05 |
| Last Update Date | 2023-03-20 |