| NPI | 1750050761 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC1900X Psychologist, Counseling (Licence: TX 38708) |
| Additional Taxonomies | 103TC1900X Psychologist, Counseling (Licence: PA PS019658) |
| Enumeration Date | 2021-09-13 |
| Last Update Date | 2024-09-11 |