| NPI | 1447522859 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: UT 10086571-2501) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: FL PY9246) |
| Enumeration Date | 2012-01-31 |
| Last Update Date | 2017-01-09 |