| NPI | 1336358431 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: TX 30028) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: TX 22002) |
| 103TB0200X Psychologist Cognitive & Behavioral (Licence: TX 22002) | |
| 103TF0000X Psychologist Family (Licence: TX 22002) | |
| 103TS0200X Psychologist School (Licence: TX 22002) | |
| Enumeration Date | 2007-05-22 |
| Last Update Date | 2021-06-17 |