| NPI | 1033076641 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: TX 39661) |
| Additional Taxonomies | 103TS0200X Psychologist, School (Licence: TX 72383) |
| Enumeration Date | 2026-01-06 |
| Last Update Date | 2026-01-06 |