| NPI | 1699071852 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: TX 37760) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: TX 65233) |
| Enumeration Date | 2011-02-07 |
| Last Update Date | 2021-01-28 |