| NPI | 1962499814 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: TX 31593) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: TX 31593) |
| Enumeration Date | 2005-10-05 |
| Last Update Date | 2012-04-18 |