| NPI | 1114142585 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: TX 2-2200) |
| Additional Taxonomies | 103TA0700X Psychologist, Adult Development & Aging (Licence: TX 2-2200) |
| 103TB0200X Psychologist, Cognitive & Behavioral (Licence: TX 2-2200) | |
| 103TC0700X Psychologist, Clinical (Licence: TX 2-2200) | |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: TX 2-2200) | |
| 103TE1100X Psychologist, Exercise & Sports (Licence: TX 2-2200) | |
| 103TF0000X Psychologist, Family (Licence: TX 2-2200) | |
| 103TH0004X Psychologist, Health (Licence: TX 2-2200) | |
| 103TH0100X Psychologist, Health Service (Licence: TX 2-2200) | |
| Enumeration Date | 2007-04-13 |
| Last Update Date | 2007-07-08 |