| NPI | 1174011779 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC1900X Psychologist, Counseling (Licence: TX 1-2556) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: TX 09274) |
| Enumeration Date | 2018-04-29 |
| Last Update Date | 2018-04-29 |