| NPI | 1548945991 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TS0200X Psychologist School (Licence: TX 39549) |
| Additional Taxonomies | 103TS0200X Psychologist School (Licence: TX 71999) |
| Enumeration Date | 2023-06-21 |
| Last Update Date | 2023-06-21 |