| NPI | 1598014292 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: WV 1123) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: TX 36616) |
| Enumeration Date | 2012-09-10 |
| Last Update Date | 2022-04-07 |