| NPI | 1013998657 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC1900X Psychologist, Counseling (Licence: TX 4161) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: TX 4161) |
| 103TC0700X Psychologist, Clinical (Licence: TX 24161) | |
| Enumeration Date | 2005-11-10 |
| Last Update Date | 2014-01-30 |