| NPI | 1801169081 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: TX 33413) |
| Additional Taxonomies | 103TS0200X Psychologist, School (Licence: TX 33413) |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: TX 33413) | |
| Enumeration Date | 2012-02-17 |
| Last Update Date | 2024-01-26 |