| NPI | 1265523484 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: TX 22101) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: TX 22101) |
| Enumeration Date | 2006-09-27 |
| Last Update Date | 2012-04-06 |