| NPI | 1417746413 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TM1800X Psychologist, Intellectual & Developmental Disabilities (Licence: TX 34184) |
| Additional Taxonomies | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: TX 34184) |
| Enumeration Date | 2025-05-05 |
| Last Update Date | 2025-05-05 |