| NPI | 1457408841 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC1900X Psychologist Counseling (Licence: TX 22958) |
| Additional Taxonomies | 103TA0400X Psychologist Addiction (Substance Use Disorder) (Licence: TX 22958) |
| 103TF0200X Psychologist Forensic (Licence: TX 22958) | |
| 103TS0200X Psychologist School (Licence: TX 30315) | |
| Enumeration Date | 2007-01-05 |
| Last Update Date | 2010-11-10 |