| NPI | 1598124331 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: TX 0000) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: WI 3384-57) |
| 103T00000X Psychologist (Licence: AL 2019) | |
| Enumeration Date | 2016-02-22 |
| Last Update Date | 2018-03-17 |