| NPI | 1508225145 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: TX 34827) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: TX 34827) |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: TX 34827) | |
| Enumeration Date | 2016-02-10 |
| Last Update Date | 2024-09-05 |