| NPI | 1316075146 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: TX 22331) |
| Additional Taxonomies | 103TS0200X Psychologist, School (Licence: TX 30453) |
| 106H00000X Marriage & Family Therapist (Licence: TX 886) | |
| Enumeration Date | 2007-03-01 |
| Last Update Date | 2013-04-04 |