| NPI | 1215606975 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: IA 098290) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: IA 098290) |
| 103TC0700X Psychologist Clinical (Licence: IA 098290) | |
| Enumeration Date | 2021-09-07 |
| Last Update Date | 2022-02-10 |