| 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 |