| NPI | 1750150918 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: TX 39994) |
| Additional Taxonomies | 103TC1900X Psychologist Counseling (Licence: TX 39994) |
| Enumeration Date | 2023-12-28 |
| Last Update Date | 2023-12-28 |