| NPI | 1245613322 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: MO R0316) |
| Additional Taxonomies | 103TF0200X Psychologist, Forensic |
| 103TC0700X Psychologist, Clinical (Licence: MO R0316) | |
| Enumeration Date | 2015-07-07 |
| Last Update Date | 2021-04-23 |