| NPI | 1215239348 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: UT 7759498-2501) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: UT 7759498-2501) |
| 103TC0700X Psychologist, Clinical (Licence: UT 7759498-2501) | |
| 103TH0004X Psychologist, Health (Licence: UT 7759498-2501) | |
| Enumeration Date | 2010-11-22 |
| Last Update Date | 2013-05-10 |