| NPI | 1003122805 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: IA 094308) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: AZ LASAC-13200) |
| Enumeration Date | 2010-08-31 |
| Last Update Date | 2023-11-16 |