| NPI | 1023197431 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: MD 05505) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: HI 840) |
| 103G00000X Clinical Neuropsychologist (Licence: HI 840) | |
| Enumeration Date | 2006-11-04 |
| Last Update Date | 2025-09-04 |