| NPI | 1417381203 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: TX 36143) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NC 4455) |
| 103T00000X Psychologist (Licence: TX 36143) | |
| Enumeration Date | 2013-08-28 |
| Last Update Date | 2016-06-07 |