| NPI | 1831667385 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: TX 22060) |
| Additional Taxonomies | 103TF0000X Psychologist, Family (Licence: TX 857) |
| Enumeration Date | 2018-11-02 |
| Last Update Date | 2018-11-02 |