| NPI | 1568484277 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: TX 24018) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NH 216) |
| Enumeration Date | 2006-07-24 |
| Last Update Date | 2011-09-02 |