| NPI | 1619123973 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: TX 33977) |
| Additional Taxonomies | 103TS0200X Psychologist, School (Licence: TX 33893) |
| Enumeration Date | 2008-08-18 |
| Last Update Date | 2022-10-07 |