| NPI | 1710553573 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: TX 38710) |
| Additional Taxonomies | 103TA0400X Psychologist, Addiction (Substance Use Disorder) (Licence: TX 38710) |
| 103TB0200X Psychologist, Cognitive & Behavioral (Licence: TX 38710) | |
| 103TC0700X Psychologist, Clinical (Licence: TX 38710) | |
| 103TH0004X Psychologist, Health (Licence: TX 38710) | |
| Enumeration Date | 2021-06-02 |
| Last Update Date | 2023-12-28 |