| NPI | 1003478843 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MA 11543) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: MA 11543) |
| Enumeration Date | 2019-07-02 |
| Last Update Date | 2024-09-05 |