| NPI | 1568794493 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: TN P1987) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: TN P1987) |
| Enumeration Date | 2010-02-03 |
| Last Update Date | 2013-04-01 |