| NPI | 1396746947 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: TX 2-2996) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: TX 873LMFT) |
| Enumeration Date | 2005-08-04 |
| Last Update Date | 2012-01-19 |