| NPI | 1194718650 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: TX 31520) |
| Additional Taxonomies | 103TF0200X Psychologist, Forensic (Licence: TX 31520) |
| Enumeration Date | 2005-08-30 |
| Last Update Date | 2022-04-25 |