| 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 |