| NPI | 1417344961 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: TX 38590) |
| Additional Taxonomies | 103TC1900X Psychologist, Counseling (Licence: AL 1949) |
| Enumeration Date | 2015-04-22 |
| Last Update Date | 2024-01-15 |