| NPI | 1962196188 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: TX 39921) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: TX 39921) |
| Enumeration Date | 2023-06-08 |
| Last Update Date | 2023-12-28 |