NPI | 1174627186 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103T00000X Psychologist (Licence: TX 24411) |
Additional Taxonomies | 103TS0200X Psychologist School (Licence: TX 6244) |
Enumeration Date | 2006-09-11 |
Last Update Date | 2022-02-21 |