NPI | 1083846810 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: UT 370989-2501) |
Additional Taxonomies | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: UT 370989-2501) |
103TC1900X Psychologist, Counseling (Licence: UT 370989-2501) | |
103TC2200X Psychologist, Clinical Child & Adolescent (Licence: UT 370989-2501) | |
103TE1100X Psychologist, Exercise & Sports (Licence: UT 370989-2501) | |
103TF0000X Psychologist, Family (Licence: UT 370989-2501) | |
103TH0004X Psychologist, Health (Licence: UT 370989-2501) | |
103TM1800X Psychologist, Intellectual & Developmental Disabilities (Licence: UT 370989-2501) | |
103TP2701X Psychologist, Group Psychotherapy (Licence: UT 370989-2501) | |
103TS0200X Psychologist, School (Licence: UT 370989-2501) | |
Enumeration Date | 2009-08-12 |
Last Update Date | 2009-08-12 |