| NPI | 1962494955 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: TX 20868) |
| Additional Taxonomies | 103TB0200X Psychologist, Cognitive & Behavioral |
| 103TC2200X Psychologist, Clinical Child & Adolescent | |
| 103TF0000X Psychologist, Family | |
| 103TH0100X Psychologist, Health Service | |
| 103T00000X Psychologist | |
| 103TM1800X Psychologist, Intellectual & Developmental Disabilities | |
| 103T00000X Psychologist (Licence: TX 20868) | |
| 103G00000X Clinical Neuropsychologist (Licence: TX 20868) | |
| 103TA0400X Psychologist, Addiction (Substance Use Disorder) | |
| Enumeration Date | 2005-08-17 |
| Last Update Date | 2010-07-02 |