| NPI | 1114330701 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEE DOBBS Credentiling 817-306-0215 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist |
| Additional Taxonomies | 103TC2200X Psychologist Clinical Child & Adolescent |
| 209800000X Legal Medicine | |
| Enumeration Date | 2014-06-11 |
| Last Update Date | 2014-10-01 |