| NPI | 1104130814 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC1900X Psychologist, Counseling (Licence: TX 34365) |
| Additional Taxonomies | 103TB0200X Psychologist, Cognitive & Behavioral |
| 103TE1100X Psychologist, Exercise & Sports | |
| 103TH0004X Psychologist, Health | |
| 103TP2701X Psychologist, Group Psychotherapy | |
| Enumeration Date | 2010-08-05 |
| Last Update Date | 2010-08-05 |