| NPI | 1619309465 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: TX 36594) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: AL 930) |
| Enumeration Date | 2013-08-04 |
| Last Update Date | 2021-04-20 |