| NPI | 1548829476 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: TX 78640) |
| Additional Taxonomies | 102L00000X Psychoanalyst (Licence: TX 78640) |
| Enumeration Date | 2019-06-13 |
| Last Update Date | 2019-06-13 |