| NPI | 1427178094 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TM1800X Psychologist Mental Retardation & Developmental Disabilities (Licence: TX 23392) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: TX 23392) |
| Enumeration Date | 2007-03-29 |
| Last Update Date | 2012-01-10 |