| NPI | 1215109194 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: TX 36218) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NY 017592) |
| Enumeration Date | 2008-03-31 |
| Last Update Date | 2016-04-25 |