| NPI | 1699983098 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: TX 24014) |
| Additional Taxonomies | 104100000X Social Worker |
| 106H00000X Marriage & Family Therapist (Licence: TX 1894) | |
| Enumeration Date | 2007-05-18 |
| Last Update Date | 2007-07-08 |