Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC2200X | Clinical Child & Adolescent Psychologist |
NPI | 1023491321 |
---|---|
Provider Name | Khalid Rashdan |
First Address | Fort Worth, TX 76107-1236 |
Second Address | Fort Worth, TX 76107-1200 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/07/2015 |
Last Update Date | 04/07/2015 |