| NPI | 1841546041 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: NC 6101) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: SC 1764) |
| 103TC0700X Psychologist, Clinical (Licence: NC 6101) | |
| 103TC0700X Psychologist, Clinical (Licence: TX 37575) | |
| 103TF0200X Psychologist, Forensic (Licence: TX 37575) | |
| Enumeration Date | 2012-07-25 |
| Last Update Date | 2024-04-02 |