| NPI | 1093293680 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: OR 3430) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: KS 2858) |
| Enumeration Date | 2018-08-06 |
| Last Update Date | 2021-09-09 |