| NPI | 1700832961 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: TX 33143) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: LA 298) |
| Enumeration Date | 2006-05-26 |
| Last Update Date | 2008-03-12 |