| NPI | 1992850978 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: TX 32801) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: TX 32801) |
| 103TC1900X Psychologist, Counseling (Licence: TX 32801) | |
| 103TH0100X Psychologist, Health Service (Licence: TX 32801) | |
| Enumeration Date | 2007-01-23 |
| Last Update Date | 2007-07-08 |