| NPI | 1982194478 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: TX 38196) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: TX 38196) |
| Enumeration Date | 2018-05-10 |
| Last Update Date | 2022-05-18 |