| NPI | 1023354321 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: TX 36901) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: TX 36901) |
| 103TF0200X Psychologist Forensic | |
| Enumeration Date | 2012-12-14 |
| Last Update Date | 2021-04-12 |