| NPI | 1194172312 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist |
| 103TF0200X Psychologist, Forensic | |
| Enumeration Date | 2016-05-17 |
| Last Update Date | 2025-05-16 |