| NPI | 1942753298 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC1900X Psychologist, Counseling |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: TX 76078) |
| Enumeration Date | 2016-08-03 |
| Last Update Date | 2022-07-07 |