| NPI | 1700177391 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: TX 34782) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: OK 1248) |
| Enumeration Date | 2011-04-29 |
| Last Update Date | 2016-02-02 |