| NPI | 1023459971 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: MO 2013020719) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: MO 2013020719) |
| Enumeration Date | 2013-07-08 |
| Last Update Date | 2021-05-24 |