| NPI | 1922098631 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: NC 2858) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: TN P0000001868) |
| 103TC0700X Psychologist, Clinical (Licence: TN P0000001868) | |
| 103TC0700X Psychologist, Clinical (Licence: NC 2858) | |
| Enumeration Date | 2005-10-24 |
| Last Update Date | 2011-11-08 |