| NPI | 1699912394 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: UT 379374-2501) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: UT 379374-2501) |
| 103TH0004X Psychologist, Health (Licence: UT 379374-2501) | |
| 103TP2701X Psychologist, Group Psychotherapy (Licence: UT 379374-2501) | |
| Enumeration Date | 2009-01-16 |
| Last Update Date | 2022-07-21 |