| NPI | 1942349451 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: TX 23147) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: TX 23147) |
| 103TP0016X Psychologist, Prescribing (Medical) (Licence: LA MP.0661) | |
| Enumeration Date | 2007-02-05 |
| Last Update Date | 2013-03-30 |