| NPI | 1568473817 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TA0400X Psychologist, Addiction (Substance Use Disorder) (Licence: TX 24969) |
| Additional Taxonomies | 103TA0700X Psychologist, Adult Development & Aging (Licence: TX 24969) |
| 103TF0000X Psychologist, Family (Licence: TX 24969) | |
| 103TP2701X Psychologist, Group Psychotherapy (Licence: TX 24969) | |
| Enumeration Date | 2006-08-11 |
| Last Update Date | 2007-07-08 |