| NPI | 1245686468 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: WV 1146) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: VA 0810005380) |
| Enumeration Date | 2016-05-06 |
| Last Update Date | 2022-04-08 |