| NPI | 1306080544 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: UT 6866553-2501) |
| Additional Taxonomies | 103TB0200X Psychologist Cognitive & Behavioral (Licence: UT 6866553-2501) |
| 103TP2701X Psychologist Group Psychotherapy (Licence: UT 6866553-2501) | |
| Enumeration Date | 2009-04-30 |
| Last Update Date | 2019-05-16 |