| NPI | 1407079361 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: TX 22835) |
| Additional Taxonomies | 101Y00000X Counselor |
| 101YP2500X Counselor, Professional | |
| 103T00000X Psychologist | |
| 103TA0700X Psychologist, Adult Development & Aging | |
| 103TF0000X Psychologist, Family | |
| Enumeration Date | 2007-04-10 |
| Last Update Date | 2012-10-10 |