| NPI | 1376773572 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: TX 34125) |
| Additional Taxonomies | 103TS0200X Psychologist, School (Licence: TX 33864) |
| Enumeration Date | 2009-07-22 |
| Last Update Date | 2010-06-10 |