| NPI | 1972547842 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: TX 33122) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: TX 17104) |
| 103TF0200X Psychologist, Forensic (Licence: TX 33122) | |
| 146L00000X Emergency Medical Technician, Paramedic (Licence: TX 10457) | |
| Enumeration Date | 2006-06-15 |
| Last Update Date | 2023-04-06 |