| NPI | 1043263759 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: TX LPC18881) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: TX LMFT 5087) |
| Enumeration Date | 2006-05-17 |
| Last Update Date | 2007-12-04 |