| NPI | 1770603805 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: AR 86-04P) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: TX 7651) |
| 103T00000X Psychologist (Licence: TX 33116) | |
| 103TF0200X Psychologist Forensic (Licence: AR 86-04P) | |
| 103TF0200X Psychologist Forensic (Licence: TX 33116) | |
| 106H00000X Marriage & Family Therapist (Licence: TX 1831) | |
| Enumeration Date | 2007-03-30 |
| Last Update Date | 2008-02-04 |