| NPI | 1679836001 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: TX 37176) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: TX 67890) |
| Enumeration Date | 2012-06-20 |
| Last Update Date | 2016-02-15 |