| NPI | 1992028237 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: TX 32664) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: TX 32664) |
| 101YP2500X Counselor, Professional (Licence: TX 32664) | |
| 103G00000X Clinical Neuropsychologist (Licence: TX 32664) | |
| 103TA0400X Psychologist, Addiction (Substance Use Disorder) (Licence: TX 32664) | |
| 103TB0200X Psychologist, Cognitive & Behavioral (Licence: TX 32664) | |
| 103TC1900X Psychologist, Counseling (Licence: TX 32664) | |
| 103TM1800X Psychologist, Intellectual & Developmental Disabilities (Licence: TX 32664) | |
| Enumeration Date | 2010-03-01 |
| Last Update Date | 2013-07-15 |