| NPI | 1245299056 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: UT 973493072501) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: UT 973493072501) |
| 103T00000X Psychologist (Licence: UT 973493072501) | |
| 103TF0000X Psychologist, Family (Licence: UT 973493072501) | |
| 103TH0100X Psychologist, Health Service (Licence: UT 973493072501) | |
| 103TR0400X Psychologist, Rehabilitation (Licence: UT 973493072501) | |
| Enumeration Date | 2006-03-21 |
| Last Update Date | 2021-03-04 |