| NPI | 1326109356 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: TX 2-3276) |
| Additional Taxonomies | 103TF0000X Psychologist, Family (Licence: TX 2-3276) |
| 103T00000X Psychologist (Licence: TX 2-3276) | |
| 103TR0400X Psychologist, Rehabilitation (Licence: TX 2-3276) | |
| Enumeration Date | 2006-12-13 |
| Last Update Date | 2007-12-13 |