| NPI | 1972622678 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: TX 23038) |
| Additional Taxonomies | 103TA0400X Psychologist Addiction (Substance Use Disorder) (Licence: TX 23038) |
| 103TC1900X Psychologist Counseling (Licence: TX 23038) | |
| Enumeration Date | 2007-03-27 |
| Last Update Date | 2007-07-08 |