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 |