| NPI | 1063774446 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: TX 36119) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: 20216) |
| Enumeration Date | 2012-06-12 |
| Last Update Date | 2025-03-26 |