| NPI | 1902881550 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: TX 22427) |
| Additional Taxonomies | 103TS0200X Psychologist, School (Licence: TX 6090) |
| Enumeration Date | 2005-12-07 |
| Last Update Date | 2009-04-21 |