| NPI | 1467606251 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: TX 20508) |
| Additional Taxonomies | 103TC1900X Psychologist, Counseling (Licence: TX 20508) |
| Enumeration Date | 2008-11-06 |
| Last Update Date | 2012-10-11 |