| NPI | 1700890571 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: KY 173223) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: VA 0810003670) |
| 103TC0700X Psychologist Clinical (Licence: VA 0810003670) | |
| 103TC0700X Psychologist Clinical (Licence: TN PHD3062) | |
| Enumeration Date | 2006-07-28 |
| Last Update Date | 2018-12-07 |