| NPI | 1508863036 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: TX 21833) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: TX 21833) |
| 103G00000X Clinical Neuropsychologist (Licence: TX 30391) | |
| 103TC0700X Psychologist, Clinical (Licence: TX 21833) | |
| 103TC0700X Psychologist, Clinical (Licence: TX 30391) | |
| Enumeration Date | 2005-06-30 |
| Last Update Date | 2024-04-02 |