| NPI | 1437605797 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: TX 37179) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: TX 37179) |
| 103TF0200X Psychologist, Forensic (Licence: TX 37179) | |
| 103G00000X Clinical Neuropsychologist (Licence: TX 37179) | |
| Enumeration Date | 2016-08-28 |
| Last Update Date | 2026-06-19 |