| NPI | 1336294891 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: TX 22993) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: TX 22993) |
| 103TR0400X Psychologist, Rehabilitation (Licence: TX 22993) | |
| 103TH0004X Psychologist, Health (Licence: TX 22993) | |
| Enumeration Date | 2007-01-24 |
| Last Update Date | 2015-11-24 |