| NPI | 1821067380 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: TX 24595) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: TX 16836) |
| Enumeration Date | 2006-03-16 |
| Last Update Date | 2024-02-20 |