| NPI | 1558603068 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: TX 36319) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: TX 36319) |
| 103TC0700X Psychologist, Clinical (Licence: TX 36319) | |
| Enumeration Date | 2013-03-22 |
| Last Update Date | 2013-03-22 |