| NPI | 1023509858 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: WI 5201) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: WI 5201) |
| 103T00000X Psychologist (Licence: OH P.08314) | |
| 103G00000X Clinical Neuropsychologist (Licence: OH P.08314) | |
| Enumeration Date | 2018-05-29 |
| Last Update Date | 2026-06-08 |