| NPI | 1760834758 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: TX 37859) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: WI vetpro) |
| Enumeration Date | 2016-07-01 |
| Last Update Date | 2018-08-02 |