| NPI | 1184960304 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: HI PSY-2194) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: HI PSY-2194) |
| Enumeration Date | 2012-12-15 |
| Last Update Date | 2025-04-23 |