| NPI | 1881963700 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: UT 9039444-2501) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: HI PSY-1295) |
| Enumeration Date | 2011-12-21 |
| Last Update Date | 2022-04-13 |