| NPI | 1922343920 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: TX 12050) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: TX 4154) |
| Enumeration Date | 2012-12-01 |
| Last Update Date | 2012-12-01 |