| NPI | 1053436048 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: TX 11374) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 101YP2500X Counselor, Professional (Licence: AR P9908019) | |
| 101YP2500X Counselor, Professional (Licence: TX 11374) | |
| 103TC0700X Psychologist, Clinical (Licence: AR 87-1E) | |
| 103TC0700X Psychologist, Clinical (Licence: TX 1-2444) | |
| Enumeration Date | 2007-03-20 |
| Last Update Date | 2024-03-18 |