| NPI | 1669245114 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: TX 39810) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: UT 13021318-2501) |
| Enumeration Date | 2023-11-06 |
| Last Update Date | 2023-11-06 |