| NPI | 1093008963 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MA 11756) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: WI 2931) |
| 103T00000X Psychologist (Licence: WI 2931) | |
| Enumeration Date | 2011-05-25 |
| Last Update Date | 2025-05-14 |