| NPI | 1114945649 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: TX 24895) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: TX 3853) |
| Enumeration Date | 2006-07-17 |
| Last Update Date | 2019-04-29 |