| NPI | 1538516224 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: TX 36585) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: 94919) |
| 103TC0700X Psychologist, Clinical (Licence: TX 36585) | |
| Enumeration Date | 2016-05-23 |
| Last Update Date | 2024-05-01 |