| NPI | 1598976219 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: UT 363492-2501) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: HI PSY-903) |
| Enumeration Date | 2007-05-24 |
| Last Update Date | 2007-07-08 |