| NPI | 1609902311 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: MD 04706) |
| Additional Taxonomies | 103TA0400X Psychologist Addiction (Substance Use Disorder) (Licence: MD 04706) |
| 103TA0700X Psychologist Adult Development & Aging (Licence: MD 04706) | |
| 103TA0400X Psychologist Addiction (Substance Use Disorder) (Licence: TX 34964) | |
| 103TA0700X Psychologist Adult Development & Aging (Licence: TX 34964) | |
| 103TC0700X Psychologist Clinical (Licence: TX 34964) | |
| 103TB0200X Psychologist Cognitive & Behavioral (Licence: TX 34964) | |
| 103TP2701X Psychologist Group Psychotherapy (Licence: TX 34964) | |
| 103TC1900X Psychologist Counseling (Licence: TX 34964) | |
| 103TH0004X Psychologist Health (Licence: TX 34964) | |
| 103TH0100X Psychologist Health Service (Licence: TX 34964) | |
| Enumeration Date | 2007-02-26 |
| Last Update Date | 2013-04-15 |