| NPI | 1578661146 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: TX 23661) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: TX 2793) |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2007-07-08 |