| NPI | 1720174477 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: TX 32638) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: TX 32638) |
| Enumeration Date | 2006-10-04 |
| Last Update Date | 2026-01-14 |