| NPI | 1851829592 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: TX 38338) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: NE 11172) |
| Enumeration Date | 2017-05-25 |
| Last Update Date | 2026-02-25 |