| NPI | 1477091650 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC1900X Psychologist, Counseling (Licence: UT 11642799-2501) |
| Additional Taxonomies | 103TC1900X Psychologist, Counseling |
| Enumeration Date | 2017-02-07 |
| Last Update Date | 2024-03-13 |