| NPI | 1528094521 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: TX 33973) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: TN 1585) |
| Enumeration Date | 2006-06-23 |
| Last Update Date | 2009-10-08 |