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 |