| NPI | 1891921805 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CO 1973) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: TX 34152) |
| Enumeration Date | 2009-06-04 |
| Last Update Date | 2019-06-11 |