| NPI | 1891937900 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: TX 38296) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: TX 63333) |
| Enumeration Date | 2009-04-03 |
| Last Update Date | 2019-10-10 |