| NPI | 1003337767 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: NM PSY1474) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: NM PSY1474) |
| Enumeration Date | 2017-07-03 |
| Last Update Date | 2023-12-06 |