| NPI | 1811035579 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: TX 23878) |
| Additional Taxonomies | 103TH0100X Psychologist, Health Service (Licence: TX 23878) |
| 103TR0400X Psychologist, Rehabilitation (Licence: TX 23878) | |
| Enumeration Date | 2007-02-02 |
| Last Update Date | 2007-07-08 |