| NPI | 1114936614 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 207QA0000X Family Medicine, Adolescent Medicine (Licence: TX E1307) |
| 2080A0000X Pediatrics, Adolescent Medicine (Licence: TX E1307) | |
| Enumeration Date | 2006-08-05 |
| Last Update Date | 2025-09-11 |