| NPI | 1063811735 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: TX 36418) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: TX 7323) |
| Enumeration Date | 2014-08-19 |
| Last Update Date | 2024-02-21 |