| NPI | 1154565729 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: UT 9524802-2501) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: UT 9524802-2501) |
| 103TA0700X Psychologist, Adult Development & Aging (Licence: UT 9524802-2501) | |
| 103TB0200X Psychologist, Cognitive & Behavioral (Licence: UT 9524802-2501) | |
| 103TC0700X Psychologist, Clinical (Licence: UT 9524802-2501) | |
| 103TF0200X Psychologist, Forensic (Licence: UT 9524802-2501) | |
| 103TH0100X Psychologist, Health Service (Licence: UT 9524802-2501) | |
| 103TM1800X Psychologist, Intellectual & Developmental Disabilities (Licence: UT 9524802-2501) | |
| Enumeration Date | 2009-04-27 |
| Last Update Date | 2019-11-05 |