| NPI | 1114088978 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TS0200X Psychologist, School (Licence: TX 30424) |
| Additional Taxonomies | 103TC1900X Psychologist, Counseling (Licence: TX 22876) |
| Enumeration Date | 2006-12-13 |
| Last Update Date | 2025-09-11 |