| NPI | 1396831327 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: TX 22463) |
| Additional Taxonomies | 103TS0200X Psychologist, School (Licence: TX 6094) |
| Enumeration Date | 2006-10-05 |
| Last Update Date | 2007-07-08 |