| NPI | 1952302671 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: TX 22909) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: TX 002784) |
| Enumeration Date | 2005-08-03 |
| Last Update Date | 2007-07-08 |