| NPI | 1538944863 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TH0004X Psychologist, Health (Licence: TX 39962) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: TX 39962) |
| Enumeration Date | 2023-08-25 |
| Last Update Date | 2024-10-22 |