| NPI | 1033239827 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: UT 295041-2504) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: UT 295041-3501) |
| Enumeration Date | 2007-03-29 |
| Last Update Date | 2021-09-21 |