| NPI | 1639487598 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: TN 3496) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: TX 36518) |
| Enumeration Date | 2010-09-14 |
| Last Update Date | 2023-09-05 |