| NPI | 1235823568 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: TX 40712) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: TX 78881) |
| Enumeration Date | 2023-06-08 |
| Last Update Date | 2025-09-19 |