| NPI | 1316435134 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: TX 39832) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: TX 75036) |
| Enumeration Date | 2018-04-26 |
| Last Update Date | 2025-01-27 |