| NPI | 1861509432 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: TX 33980) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: TX 15318) |
| 103K00000X Behavior Analyst (Licence: TX 1778) | |
| 103T00000X Psychologist (Licence: TX 33980) | |
| Enumeration Date | 2006-08-23 |
| Last Update Date | 2024-05-14 |