| NPI | 1962565036 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: UT 12847003-2501) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: AZ 3490) |
| Enumeration Date | 2006-12-19 |
| Last Update Date | 2023-08-23 |