| NPI | 1760561781 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: TX 22032) |
| Additional Taxonomies | 103TH0100X Psychologist, Health Service (Licence: TX 22032) |
| Enumeration Date | 2006-11-02 |
| Last Update Date | 2014-09-12 |