| NPI | 1851656367 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: TX 31734) |
| Additional Taxonomies | 103TS0200X Psychologist, School (Licence: TX 31816) |
| Enumeration Date | 2012-07-10 |
| Last Update Date | 2012-07-10 |