| NPI | 1558411025 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: WY 465) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: UT 346718-2501) |
| Enumeration Date | 2007-01-10 |
| Last Update Date | 2016-10-14 |