| NPI | 1437301314 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: TX 33940) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: TX 33940) |
| Enumeration Date | 2008-10-22 |
| Last Update Date | 2016-05-18 |