| NPI | 1215034632 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: TX 21380) |
| Additional Taxonomies | 103TS0200X Psychologist, School (Licence: TX 30322) |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2007-07-08 |