| NPI | 1952920100 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC1900X Psychologist Counseling (Licence: TX 37537) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: TX 37537) |
| Enumeration Date | 2020-04-08 |
| Last Update Date | 2025-10-02 |