| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
|
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist |
| Additional Taxonomies | 103TB0200X Psychologist, Cognitive & Behavioral |
| 103TC2200X Psychologist, Clinical Child & Adolescent |
| 103TM1800X Psychologist, Intellectual & Developmental Disabilities |
| 103T00000X Psychologist |
| 103TP0814X Psychologist, Psychoanalysis |
| 101YM0800X Counselor, Mental Health |
| 101YP2500X Counselor, Professional |
| 102L00000X Psychoanalyst |
| 103K00000X Behavior Analyst |
| Enumeration Date | 2026-03-16 |
| Last Update Date | 2026-03-16 |