| NPI | 1699492827 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: TX 39561) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: CA 33675) |
| Enumeration Date | 2022-10-27 |
| Last Update Date | 2025-10-08 |