| NPI | 1780052605 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: TX 36992) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: TX 36992) |
| Enumeration Date | 2015-09-09 |
| Last Update Date | 2021-11-07 |