| NPI | 1821794694 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: TX 41260) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: TX 86423) |
| Enumeration Date | 2023-02-03 |
| Last Update Date | 2026-06-16 |