| NPI | 1578887733 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: TX 23273) |
| Additional Taxonomies | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: TX 23273) |
| 103TF0000X Psychologist, Family (Licence: TX 23273) | |
| 103TP2701X Psychologist, Group Psychotherapy (Licence: TX 23273) | |
| Enumeration Date | 2010-03-17 |
| Last Update Date | 2010-03-17 |