| NPI | 1861948606 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TH0004X Psychologist, Health (Licence: TX 38756) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: TX 38756) |
| 103T00000X Psychologist (Licence: NY 024647) | |
| Enumeration Date | 2016-08-31 |
| Last Update Date | 2026-06-18 |