| NPI | 1467468140 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: TX 24272) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: TX 2-4272) |
| 103TC0700X Psychologist, Clinical (Licence: TX 24272) | |
| Enumeration Date | 2006-08-01 |
| Last Update Date | 2022-07-28 |