| NPI | 1285629055 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: TX 38103) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: TX 18907) |
| Enumeration Date | 2005-09-16 |
| Last Update Date | 2019-10-11 |