| NPI | 1104918473 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: TX 20353) |
| Additional Taxonomies | 103TS0200X Psychologist School (Licence: TX 6433) |
| Enumeration Date | 2006-09-28 |
| Last Update Date | 2007-07-08 |