| NPI | 1629299367 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: AZ 1583) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: TX 33310) |
| 103G00000X Clinical Neuropsychologist (Licence: MT 178) | |
| 103TA0700X Psychologist, Adult Development & Aging (Licence: AZ 1583) | |
| 103TA0700X Psychologist, Adult Development & Aging (Licence: TX 33310) | |
| 103TA0700X Psychologist, Adult Development & Aging (Licence: MT 178) | |
| Enumeration Date | 2007-05-01 |
| Last Update Date | 2012-04-23 |