| NPI | 1396047270 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TF0200X Psychologist Forensic |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: SD 577) |
| 103TC0700X Psychologist Clinical (Licence: VA 0810004580) | |
| 103TC0700X Psychologist Clinical (Licence: TX 36625) | |
| 103TF0200X Psychologist Forensic (Licence: 577) | |
| 103TF0200X Psychologist Forensic (Licence: VA 0810004580) | |
| 103TF0200X Psychologist Forensic (Licence: TX 36625) | |
| 103TF0200X Psychologist Forensic (Licence: SD 577) | |
| Enumeration Date | 2010-11-24 |
| Last Update Date | 2023-07-25 |