| NPI | 1083945869 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: TX 38315) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: TX 11724) |
| Enumeration Date | 2010-01-19 |
| Last Update Date | 2021-10-13 |