| NPI | 1992929830 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: TX 37273) |
| Additional Taxonomies | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: IL 071006599) |
| 103T00000X Psychologist (Licence: TX 37273) | |
| Enumeration Date | 2007-04-12 |
| Last Update Date | 2019-02-20 |