| NPI | 1740333871 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TA0400X Psychologist, Addiction (Substance Use Disorder) (Licence: TX TSBEP2-0810) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: TX TSBEP2-0810) |
| 103TF0000X Psychologist, Family (Licence: TX TSBEP2-0810) | |
| 103T00000X Psychologist (Licence: TX TSBEP2-0810) | |
| Enumeration Date | 2007-01-20 |
| Last Update Date | 2007-07-08 |