| 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 |