| NPI | 1619160645 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: UT 376697) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: CA PSY25080) |
| Enumeration Date | 2007-08-22 |
| Last Update Date | 2015-04-09 |