| NPI | 1720234289 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: TX 30893) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: TN P0000002801) |
| Enumeration Date | 2008-08-14 |
| Last Update Date | 2009-03-02 |