| NPI | 1467501403 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: TX 30682) |
| Additional Taxonomies | 103TS0200X Psychologist, School (Licence: TX 32077) |
| Enumeration Date | 2007-01-09 |
| Last Update Date | 2017-08-24 |