| NPI | 1639441850 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: TX 35206) |
| Additional Taxonomies | 103TC1900X Psychologist, Counseling (Licence: TX 35206) |
| Enumeration Date | 2012-02-03 |
| Last Update Date | 2018-09-29 |