| NPI | 1942218557 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: TX 31513) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NY 008532-1) |
| Enumeration Date | 2006-08-03 |
| Last Update Date | 2009-07-09 |