| NPI | 1255351177 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: TX 2-1953) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: TX 2-1953) |
| 103TB0200X Psychologist, Cognitive & Behavioral (Licence: TX 21953) | |
| 103TA0700X Psychologist, Adult Development & Aging (Licence: TX 21953) | |
| 103TF0000X Psychologist, Family (Licence: TX 21953) | |
| 103TF0200X Psychologist, Forensic (Licence: TX 21953) | |
| 103TM1800X Psychologist, Intellectual & Developmental Disabilities (Licence: TX 21953) | |
| 103TR0400X Psychologist, Rehabilitation (Licence: TX 21953) | |
| Enumeration Date | 2006-07-21 |
| Last Update Date | 2015-07-20 |