| NPI | 1700088648 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: TX 32657) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: TX 32657) |
| Enumeration Date | 2007-06-04 |
| Last Update Date | 2022-07-25 |