| NPI | 1962553032 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: TX 34349) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: TX 18212) |
| Enumeration Date | 2007-01-16 |
| Last Update Date | 2010-12-20 |