| NPI | 1568427664 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: UT 286133-2501) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: RI PS00895) |
| 103TC0700X Psychologist, Clinical (Licence: TX 36454) | |
| 103TC0700X Psychologist, Clinical (Licence: UT 286133-2501) | |
| Enumeration Date | 2006-04-20 |
| Last Update Date | 2021-12-16 |