| NPI | 1518162262 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: TX 35082) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: CO PSY0003760) |
| Enumeration Date | 2007-06-20 |
| Last Update Date | 2021-03-29 |