| NPI | 1235815275 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: UT 14272011-2501) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: UT 14272011-2501) |
| Enumeration Date | 2023-06-26 |
| Last Update Date | 2026-08-06 |