| NPI | 1073579496 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: TX 6484) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: TX 22550) |
| Enumeration Date | 2006-04-25 |
| Last Update Date | 2007-07-08 |