| NPI | 1306912449 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: TX 23844) |
| Additional Taxonomies | 103TS0200X Psychologist School (Licence: TX 6198) |
| Enumeration Date | 2006-11-28 |
| Last Update Date | 2013-10-27 |