| NPI | 1063235414 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: TX 40373) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: TX 40373) |
| 103TH0004X Psychologist, Health (Licence: TX 40373) | |
| Enumeration Date | 2024-11-04 |
| Last Update Date | 2024-11-04 |