| NPI | 1841543352 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: NV PY0750) |
| Additional Taxonomies | 103TC1900X Psychologist, Counseling (Licence: TX 34303) |
| 103TF0200X Psychologist, Forensic (Licence: NV PY0750) | |
| 103T00000X Psychologist (Licence: TX 34303) | |
| 103TC1900X Psychologist, Counseling (Licence: NV PY0750) | |
| Enumeration Date | 2012-10-22 |
| Last Update Date | 2020-07-01 |