| NPI | 1821246901 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: TX 34588) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: TX 13599) |
| Enumeration Date | 2008-09-03 |
| Last Update Date | 2012-07-13 |