| NPI | 1790406874 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC1900X Psychologist Counseling (Licence: TX 38645) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: TX 38645) |
| Enumeration Date | 2022-09-07 |
| Last Update Date | 2024-01-18 |