| NPI | 1457400582 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: TX 20408) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: TX 470) |
| 106H00000X Marriage & Family Therapist (Licence: TX 853) | |
| Enumeration Date | 2007-01-09 |
| Last Update Date | 2015-09-22 |