| NPI | 1528044195 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: LA 1180) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: TX 32143) |
| Enumeration Date | 2005-12-15 |
| Last Update Date | 2019-10-15 |