| NPI | 1922665249 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: UT 11111392-2501) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: UT 11111392-2501) |
| Enumeration Date | 2019-05-22 |
| Last Update Date | 2021-12-10 |