| NPI | 1891054870 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC1900X Psychologist, Counseling (Licence: TX 36029) |
| Additional Taxonomies | 103TC1900X Psychologist, Counseling (Licence: CO 3730) |
| Enumeration Date | 2012-05-10 |
| Last Update Date | 2025-07-06 |