| NPI | 1326090770 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: TN P-1466) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: WV 718) |
| 103TC0700X Psychologist, Clinical (Licence: TN P-1466) | |
| 103TC0700X Psychologist, Clinical (Licence: WV 718) | |
| Enumeration Date | 2006-05-16 |
| Last Update Date | 2010-10-13 |