| NPI | 1780012427 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC1900X Psychologist, Counseling (Licence: TX 36655) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: TX 36655) |
| Enumeration Date | 2013-10-16 |
| Last Update Date | 2026-07-06 |