| NPI | 1912260779 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: TX 37585) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: FL PY10489) |
| 103TC0700X Psychologist, Clinical (Licence: TX 37585) | |
| 103G00000X Clinical Neuropsychologist (Licence: LA 1549) | |
| 103TC0700X Psychologist, Clinical (Licence: FL PY10489) | |
| 103TC0700X Psychologist, Clinical (Licence: LA 1549) | |
| Enumeration Date | 2012-06-18 |
| Last Update Date | 2026-05-06 |