| NPI | 1689098113 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: TX 35074) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: TX 35074) |
| Enumeration Date | 2014-02-04 |
| Last Update Date | 2022-06-07 |