| NPI | 1033140306 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: TX 38344) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: KY 1108) |
| Enumeration Date | 2006-07-05 |
| Last Update Date | 2026-05-22 |