| NPI | 1497805659 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: TX 23178) |
| Additional Taxonomies | 103TS0200X Psychologist, School (Licence: TX 6166) |
| 103G00000X Clinical Neuropsychologist (Licence: TX 23178) | |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: TX 23178) | |
| 103TF0200X Psychologist, Forensic (Licence: TX 23178) | |
| 103TM1800X Psychologist, Intellectual & Developmental Disabilities (Licence: TX 23178) | |
| Enumeration Date | 2007-01-11 |
| Last Update Date | 2021-05-25 |