| NPI | 1245590702 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC1900X Psychologist, Counseling (Licence: AR 11-26P) |
| Additional Taxonomies | 103TC1900X Psychologist, Counseling (Licence: TX 35148) |
| Enumeration Date | 2012-05-17 |
| Last Update Date | 2012-05-17 |