| NPI | 1255432696 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: WI 1653) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: WI 1653) |
| Enumeration Date | 2006-09-26 |
| Last Update Date | 2021-02-01 |