| NPI | 1366674491 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC1900X Psychologist Counseling (Licence: TX 35031) |
| Additional Taxonomies | 103TC1900X Psychologist Counseling (Licence: IA 001123) |
| Enumeration Date | 2009-08-24 |
| Last Update Date | 2011-10-19 |