| NPI | 1174604797 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: TX 33450) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: TX 33450) |
| Enumeration Date | 2006-10-18 |
| Last Update Date | 2007-07-08 |