| NPI | 1710067145 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: TX 22293) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: TX 2-2293) |
| 106H00000X Marriage & Family Therapist (Licence: TX 1779) | |
| Enumeration Date | 2006-10-17 |
| Last Update Date | 2024-07-02 |