| NPI | 1205876133 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: UT 1088922501PSYCH) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: UT 1008923501LCSW) |
| 106H00000X Marriage & Family Therapist (Licence: UT 1008923902MFT) | |
| Enumeration Date | 2006-06-08 |
| Last Update Date | 2007-07-08 |