| 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 |