NPI | 1669687190 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: TX 32868) |
Additional Taxonomies | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: TX 32868) |
103TC2200X Psychologist, Clinical Child & Adolescent (Licence: TX 32868) | |
Enumeration Date | 2007-05-10 |
Last Update Date | 2007-12-26 |