| NPI | 1255565479 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: CT 002930) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: CT 002930) |
| Enumeration Date | 2009-05-04 |
| Last Update Date | 2023-11-10 |