| NPI | 1447366844 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: TX 39470) |
| Additional Taxonomies | 103TF0200X Psychologist Forensic (Licence: TX 39470) |
| Enumeration Date | 2006-08-21 |
| Last Update Date | 2024-05-22 |