| NPI | 1174635379 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: TX 14775) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: TX 15103) |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2024-07-11 |