| NPI | 1487860425 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: TX 33373) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: TX 33373) |
| Enumeration Date | 2007-05-15 |
| Last Update Date | 2012-08-30 |