| NPI | 1366996399 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: TX 31714) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: TX 31714) |
| Enumeration Date | 2016-08-08 |
| Last Update Date | 2023-04-13 |