| NPI | 1770772386 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: TX 21621) |
| Additional Taxonomies | 103TH0004X Psychologist Health (Licence: TX 21621) |
| Enumeration Date | 2007-10-19 |
| Last Update Date | 2014-04-18 |