| NPI | 1104590322 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: TX 10877) |
| Additional Taxonomies | 103TC1900X Psychologist, Counseling (Licence: TX 10877) |
| Enumeration Date | 2021-08-02 |
| Last Update Date | 2025-07-16 |