| NPI | 1851618870 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: TX 34564) |
| Additional Taxonomies | 103TA0700X Psychologist, Adult Development & Aging (Licence: TX 34564) |
| 103TB0200X Psychologist, Cognitive & Behavioral (Licence: TX 34564) | |
| 103TC0700X Psychologist, Clinical (Licence: TX 34564) | |
| 103TC1900X Psychologist, Counseling (Licence: TX 34564) | |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: TX 34564) | |
| 103TR0400X Psychologist, Rehabilitation (Licence: TX 34564) | |
| Enumeration Date | 2010-04-29 |
| Last Update Date | 2011-08-05 |