| NPI | 1255358057 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: TN P0000000983) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: TN P0000000983) |
| Enumeration Date | 2006-07-16 |
| Last Update Date | 2007-07-09 |