| NPI | 1790334621 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: TX 38246) |
| Additional Taxonomies | 103TC2200X Psychologist, Clinical Child & Adolescent |
| 103TC0700X Psychologist, Clinical (Licence: TX 38246) | |
| Enumeration Date | 2019-09-04 |
| Last Update Date | 2020-05-11 |