| NPI | 1245304245 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: TX 23722) |
| Additional Taxonomies | 103TA0400X Psychologist Addiction (Substance Use Disorder) (Licence: TX 23722) |
| 103TC2200X Psychologist Clinical Child & Adolescent (Licence: TX 23722) | |
| 103TH0100X Psychologist Health Service (Licence: TX 23722) | |
| 103T00000X Psychologist (Licence: TX 23722) | |
| 103TP2701X Psychologist Group Psychotherapy (Licence: TX 23722) | |
| Enumeration Date | 2006-11-20 |
| Last Update Date | 2010-12-28 |