| NPI | 1487958229 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: CA 28308) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: TX 34300) |
| 103TB0200X Psychologist, Cognitive & Behavioral (Licence: TX 34300) | |
| 103TF0200X Psychologist, Forensic (Licence: TX 34300) | |
| Enumeration Date | 2011-01-10 |
| Last Update Date | 2022-07-21 |