| NPI | 1427294115 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: TX 34212) |
| Additional Taxonomies | 103TP2701X Psychologist, Group Psychotherapy (Licence: TX 34212) |
| Enumeration Date | 2008-12-30 |
| Last Update Date | 2022-01-25 |