| NPI | 1235011008 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: TX 40790) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: TX 40790) |
| 103TC1900X Psychologist, Counseling (Licence: TX 40790) | |
| Enumeration Date | 2025-07-23 |
| Last Update Date | 2025-07-23 |