| NPI | 1548222300 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: TX 31255) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: WA PY60064343) |
| 103G00000X Clinical Neuropsychologist (Licence: TX 31255) | |
| Enumeration Date | 2006-04-05 |
| Last Update Date | 2012-05-15 |