| NPI | 1346434214 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: TX 63119) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: TX 63119) |
| 101YP2500X Counselor, Professional (Licence: TX 63119) | |
| 102L00000X Psychoanalyst (Licence: TX 63911) | |
| 103TA0700X Psychologist, Adult Development & Aging (Licence: TX 63119) | |
| 103TC1900X Psychologist, Counseling (Licence: TX 63911) | |
| 103TH0100X Psychologist, Health Service (Licence: TX 63119) | |
| 103TR0400X Psychologist, Rehabilitation (Licence: TX 63119) | |
| 106H00000X Marriage & Family Therapist (Licence: TX 63119) | |
| Enumeration Date | 2007-09-04 |
| Last Update Date | 2012-02-29 |