| NPI | 1760822027 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: TX 36720) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: SC 1262) |
| Enumeration Date | 2013-07-02 |
| Last Update Date | 2014-04-07 |