| NPI | 1780413211 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: TX 37858) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist |
| 103T00000X Psychologist (Licence: TX 37858) | |
| 103TB0200X Psychologist Cognitive & Behavioral (Licence: TX 37858) | |
| 103TM1800X Psychologist Mental Retardation & Developmental Disabilities (Licence: TX 37858) | |
| Enumeration Date | 2024-08-01 |
| Last Update Date | 2024-08-19 |