| NPI | 1871668665 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: UT 113221-2501) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: UT 113221-3902) |
| Enumeration Date | 2006-11-21 |
| Last Update Date | 2007-07-08 |