| NPI | 1598214447 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: TX 37397) |
| Additional Taxonomies | 103TS0200X Psychologist, School (Licence: TX 70891) |
| Enumeration Date | 2016-10-03 |
| Last Update Date | 2021-10-27 |