NPI | 1902156755 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: TN 3982) |
Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: TX 36320) |
103T00000X Psychologist (Licence: TX 36320) | |
Enumeration Date | 2012-09-19 |
Last Update Date | 2024-01-03 |