| NPI | 1346310869 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: UT 1141192501) |
| Additional Taxonomies | 103TC1900X Psychologist, Counseling (Licence: UT 1141192501) |
| 103TB0200X Psychologist, Cognitive & Behavioral (Licence: UT 1141192501) | |
| Enumeration Date | 2006-11-09 |
| Last Update Date | 2017-01-17 |