| NPI | 1205969706 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: TX 39649) |
| Additional Taxonomies | 103TH0100X Psychologist, Health Service (Licence: TX 39649) |
| 103TM1800X Psychologist, Intellectual & Developmental Disabilities (Licence: TX 39649) | |
| 103TP2701X Psychologist, Group Psychotherapy (Licence: CA 22371) | |
| 103TP2701X Psychologist, Group Psychotherapy (Licence: TX 39649) | |
| 103TA0700X Psychologist, Adult Development & Aging (Licence: TX 39649) | |
| 103TB0200X Psychologist, Cognitive & Behavioral (Licence: TX 39649) | |
| 103TA0700X Psychologist, Adult Development & Aging (Licence: CA 22371) | |
| 103TC0700X Psychologist, Clinical (Licence: CA PSY22371) | |
| 103TC1900X Psychologist, Counseling (Licence: TX 39649) | |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: CA 22371) | |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: TX 39649) | |
| 103TE1100X Psychologist, Exercise & Sports (Licence: CA 22371) | |
| 103TF0000X Psychologist, Family (Licence: CA 22371) | |
| 103TF0000X Psychologist, Family (Licence: TX 39649) | |
| Enumeration Date | 2007-03-13 |
| Last Update Date | 2024-03-28 |