| NPI | 1952610602 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: TX 37223) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: CT 002934) |
| 103TC0700X Psychologist, Clinical (Licence: NY 7086784) | |
| Enumeration Date | 2010-09-29 |
| Last Update Date | 2023-08-28 |