| NPI | 1295813715 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: TX 34137) |
| Additional Taxonomies | 103TS0200X Psychologist School (Licence: TX 34463) |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2012-07-09 |