| NPI | 1649200700 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: TX 24420) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: TX 24420) |
| Enumeration Date | 2006-07-04 |
| Last Update Date | 2019-12-31 |