| NPI | 1184085813 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: AZ 4584) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: TX 36876) |
| Enumeration Date | 2016-03-08 |
| Last Update Date | 2017-02-07 |