| NPI | 1881677300 |
|---|---|
| Other Name | NONE NONE |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TH0004X Psychologist Health (Licence: TX 31895) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: TX 31895) |
| Enumeration Date | 2005-11-29 |
| Last Update Date | 2019-06-24 |