| NPI | 1184017055 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: AK 148339) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: AK 911) |
| Enumeration Date | 2015-03-16 |
| Last Update Date | 2021-05-25 |