| NPI | 1497240550 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: UT 14217463-2501) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: CO Psy.00004726) |
| Enumeration Date | 2018-06-29 |
| Last Update Date | 2025-07-16 |