| NPI | 1487964706 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: TX 33636) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: TX 62990) |
| Enumeration Date | 2010-10-20 |
| Last Update Date | 2018-07-31 |