| NPI | 1881926269 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: UT 5179442-2501) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: UT 5179442-3501) |
| Enumeration Date | 2010-02-09 |
| Last Update Date | 2010-11-02 |