| NPI | 1134751845 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: TX 83490) |
| 106H00000X Marriage & Family Therapist (Licence: CA 127246) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2020-02-11 |
| Last Update Date | 2025-07-29 |