NPI | 1619195948 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103T00000X Psychologist (Licence: TX 22018) |
Additional Taxonomies | 103TS0200X Psychologist, School (Licence: TX 22018) |
Enumeration Date | 2007-04-23 |
Last Update Date | 2011-07-01 |