| NPI | 1003805078 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: TX 32373) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: TX 32373) |
| 103TH0100X Psychologist, Health Service (Licence: TX 32373) | |
| 103TC1900X Psychologist, Counseling (Licence: TX 32373) | |
| 103TF0000X Psychologist, Family (Licence: TX 32373) | |
| Enumeration Date | 2005-10-20 |
| Last Update Date | 2007-07-08 |