| NPI | 1649972639 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: TX 39443) |
| Additional Taxonomies | 103TF0200X Psychologist, Forensic |
| Enumeration Date | 2023-03-21 |
| Last Update Date | 2023-09-21 |