| NPI | 1710907795 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: UT 355025-2501) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: UT 3550252501) |
| Enumeration Date | 2006-07-20 |
| Last Update Date | 2024-05-20 |