| NPI | 1134138589 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: TX 31070) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: TX 16196) |
| Enumeration Date | 2006-08-05 |
| Last Update Date | 2016-10-05 |