NPI | 1790745248 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: UT 110924-2501) |
Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: UT 110924-2501) |
Enumeration Date | 2006-03-27 |
Last Update Date | 2007-07-08 |