| NPI | 1932404464 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: TX 34956) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: TX 64483) |
| Enumeration Date | 2011-01-13 |
| Last Update Date | 2018-09-12 |