| NPI | 1952487027 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC1900X Psychologist, Counseling (Licence: TX 2-4015) |
| Additional Taxonomies | 103TS0200X Psychologist, School (Licence: TX 3-0099) |
| Enumeration Date | 2006-10-31 |
| Last Update Date | 2011-10-06 |