| NPI | 1114143054 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC1900X Psychologist, Counseling (Licence: TX 31528) |
| Additional Taxonomies | 103TC1900X Psychologist, Counseling |
| Enumeration Date | 2007-04-18 |
| Last Update Date | 2025-08-11 |