| NPI | 1194454660 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: FL PY12373) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: VA 0810007797) |
| Enumeration Date | 2022-06-08 |
| Last Update Date | 2024-10-29 |