| NPI | 1356559637 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: TX 2-3764) |
| Additional Taxonomies | 103TC1900X Psychologist, Counseling (Licence: TX 2-3764) |
| Enumeration Date | 2007-05-18 |
| Last Update Date | 2007-07-08 |