| NPI | 1417960840 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: TX 34011) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: TX 34011) |
| 103TC1900X Psychologist Counseling (Licence: TX 34011) | |
| 103TE1100X Psychologist Exercise & Sports (Licence: TX 34011) | |
| 103TH0004X Psychologist Health (Licence: TX 34011) | |
| 103TR0400X Psychologist Rehabilitation (Licence: TX 34011) | |
| Enumeration Date | 2006-08-15 |
| Last Update Date | 2021-12-29 |