| NPI | 1861674442 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: TX 16799) |
| Additional Taxonomies | 103TF0000X Psychologist, Family (Licence: TX 16799) |
| 103TH0004X Psychologist, Health (Licence: TX 16799) | |
| 103TP2701X Psychologist, Group Psychotherapy (Licence: TX 16799) | |
| Enumeration Date | 2007-12-05 |
| Last Update Date | 2012-04-24 |