| NPI | 1205922101 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: TX 24172) |
| Additional Taxonomies | 103TH0100X Psychologist, Health Service (Licence: TX 24172) |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: TX 24172) | |
| 251E00000X Home Health (Licence: TX 24172) | |
| Enumeration Date | 2006-10-05 |
| Last Update Date | 2025-10-02 |