| NPI | 1831471697 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: TX 37328) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: TX 37328) |
| Enumeration Date | 2011-09-16 |
| Last Update Date | 2025-07-31 |