| NPI | 1306090451 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: TX PLP37459) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: CA PSY 22274) |
| Enumeration Date | 2008-11-14 |
| Last Update Date | 2016-09-20 |