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 |