| NPI | 1013643972 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: AZ PSY-005526) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: AZ PSY-005526) |
| Enumeration Date | 2022-07-25 |
| Last Update Date | 2022-08-05 |