| NPI | 1033226667 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC1900X Psychologist, Counseling (Licence: TX 36030) |
| Additional Taxonomies | 103TC1900X Psychologist, Counseling (Licence: KS 1972) |
| Enumeration Date | 2006-08-23 |
| Last Update Date | 2012-02-09 |