| NPI | 1851394381 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TH0100X Psychologist Health Service (Licence: TX 26878) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: TX 26878) |
| 103TA0700X Psychologist Adult Development & Aging (Licence: TX 26878) | |
| 103TB0200X Psychologist Cognitive & Behavioral (Licence: TX 26878) | |
| 103TF0000X Psychologist Family (Licence: TX 26878) | |
| Enumeration Date | 2005-05-30 |
| Last Update Date | 2009-02-04 |