| NPI | 1841868999 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: TX 38830) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: SC 1711) |
| Enumeration Date | 2021-06-15 |
| Last Update Date | 2022-01-21 |