| NPI | 1144226457 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: TX 31920) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: CO 2598) |
| Enumeration Date | 2005-06-22 |
| Last Update Date | 2007-07-09 |