| NPI | 1477665735 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: TX 23052) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: TX 23052) |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: TX 23052) | |
| 103TF0000X Psychologist, Family (Licence: TX 23052) | |
| 103TF0200X Psychologist, Forensic (Licence: TX 23052) | |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2015-04-21 |