| NPI | 1669711420 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: TX 37019) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: FL PY8556) |
| Enumeration Date | 2013-02-13 |
| Last Update Date | 2023-05-30 |