| NPI | 1669519575 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: TX 21032) |
| Additional Taxonomies | 103TM1800X Psychologist, Intellectual & Developmental Disabilities (Licence: TX 21032) |
| 103TS0200X Psychologist, School (Licence: TX 21032) | |
| Enumeration Date | 2007-01-31 |
| Last Update Date | 2007-07-09 |