| NPI | 1932355179 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: TX 36422) |
| Additional Taxonomies | 302R00000X Health Maintenance Organization |
| Enumeration Date | 2008-08-07 |
| Last Update Date | 2020-01-21 |