| NPI | 1932405420 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: TX 34133) |
| Additional Taxonomies | 103K00000X Behavior Analyst |
| 103TB0200X Psychologist, Cognitive & Behavioral (Licence: TX 34133) | |
| 103TC1900X Psychologist, Counseling (Licence: TX 34133) | |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: TX 34133) | |
| 103TF0000X Psychologist, Family (Licence: TX 34133) | |
| 103TM1800X Psychologist, Intellectual & Developmental Disabilities (Licence: TX 34133) | |
| 103TS0200X Psychologist, School (Licence: TX 33929) | |
| Enumeration Date | 2011-02-01 |
| Last Update Date | 2011-02-01 |