| NPI | 1801874482 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: TN P000000974) |
| Additional Taxonomies | 103TE1100X Psychologist, Exercise & Sports (Licence: TN P974) |
| 103TC0700X Psychologist, Clinical (Licence: TN P974) | |
| Enumeration Date | 2006-01-04 |
| Last Update Date | 2012-07-10 |