| NPI | 1457632820 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: UT 3100160-2501) |
| Additional Taxonomies | 103TF0200X Psychologist Forensic (Licence: UT 3100160-2501) |
| 103TC0700X Psychologist Clinical (Licence: UT 3100160-2501) | |
| 103TH0004X Psychologist Health (Licence: UT 3100160-2501) | |
| 103TR0400X Psychologist Rehabilitation (Licence: UT 3100160-2501) | |
| Enumeration Date | 2011-08-30 |
| Last Update Date | 2024-01-25 |