NPI | 1467598326 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: TX 2-3708) |
Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: TX 2-3708) |
103T00000X Psychologist (Licence: TX 2-3708) | |
Enumeration Date | 2007-01-29 |
Last Update Date | 2025-09-11 |