| NPI | 1639373780 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC2200X Psychologist Clinical Child & Adolescent (Licence: TX 32726) |
| Additional Taxonomies | 103TS0200X Psychologist School (Licence: TX 32505) |
| Enumeration Date | 2007-06-13 |
| Last Update Date | 2022-12-03 |