| NPI | 1457341356 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC1900X Psychologist, Counseling (Licence: TX 32828) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: TX 32828) |
| Enumeration Date | 2005-10-24 |
| Last Update Date | 2022-03-29 |