| NPI | 1770811291 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: TX 38492) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: NC 3879) |
| Enumeration Date | 2009-11-20 |
| Last Update Date | 2021-03-03 |