| 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 Mental Retardation & 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 |