| NPI | 1053820068 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: CO PSY.0005495) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: CO PSY.0005495) |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: TX 37747) | |
| Enumeration Date | 2017-09-21 |
| Last Update Date | 2023-11-09 |