| NPI | 1558098129 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: TX 39540) |
| Additional Taxonomies | 103TS0200X Psychologist, School (Licence: TX 71516) |
| Enumeration Date | 2022-08-04 |
| Last Update Date | 2023-11-23 |