| NPI | 1255315693 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: TX 24435) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: TX 24435) |
| 103TC0700X Psychologist, Clinical (Licence: TX 24435) | |
| 103TS0200X Psychologist, School (Licence: TX 30235) | |
| Enumeration Date | 2005-11-30 |
| Last Update Date | 2024-04-30 |