NPI | 1801809777 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103T00000X Psychologist (Licence: TX 32316) |
Additional Taxonomies | 103T00000X Psychologist (Licence: OK 330) |
Enumeration Date | 2006-08-14 |
Last Update Date | 2008-06-04 |