| NPI | 1588703813 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: TX 24685) |
| Additional Taxonomies | 103TF0200X Psychologist, Forensic (Licence: TX 9434) |
| Enumeration Date | 2007-02-05 |
| Last Update Date | 2023-01-12 |