| NPI | 1184944340 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TF0000X Psychologist, Family (Licence: TX 33988) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: TX 33988) |
| 103TC1900X Psychologist, Counseling (Licence: TX 33988) | |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: TX 33988) | |
| Enumeration Date | 2010-06-10 |
| Last Update Date | 2024-11-05 |