| NPI | 1760771844 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TS0200X Psychologist, School (Licence: TX 33587) |
| Additional Taxonomies | 103TC1900X Psychologist, Counseling (Licence: TX 34306) |
| Enumeration Date | 2011-03-29 |
| Last Update Date | 2011-10-28 |