| NPI | 1821048992 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: TX 26871) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: UT 4787371-2501) |
| Enumeration Date | 2006-05-11 |
| Last Update Date | 2012-12-19 |