| NPI | 1568584381 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: TX 38840) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: TX 18335) |
| Enumeration Date | 2007-04-04 |
| Last Update Date | 2024-05-06 |