| NPI | 1508069931 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: TX 13830) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: TX 33375) |
| Enumeration Date | 2007-06-05 |
| Last Update Date | 2026-06-18 |