| NPI | 1922898907 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: TX 40848) |
| Additional Taxonomies | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: TX 40848) |
| 103TS0200X Psychologist, School (Licence: TX 72931) | |
| Enumeration Date | 2025-05-12 |
| Last Update Date | 2025-08-26 |