| NPI | 1235549650 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: TX 36436) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: TX 36436) |
| Enumeration Date | 2014-05-07 |
| Last Update Date | 2019-05-23 |