| NPI | 1518953173 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: TX 23341) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: TX 23341) |
| 103TC1900X Psychologist Counseling (Licence: TX 23341) | |
| 103TF0000X Psychologist Family (Licence: TX 23341) | |
| Enumeration Date | 2005-09-20 |
| Last Update Date | 2023-09-06 |