| NPI | 1669425708 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: TX 25212) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: TX 000344028581) |
| Enumeration Date | 2006-05-18 |
| Last Update Date | 2021-01-06 |