| NPI | 1255578324 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: AZ PSY-003803) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: AZ 3803) |
| 103G00000X Clinical Neuropsychologist (Licence: AL 1253) | |
| Enumeration Date | 2009-01-12 |
| Last Update Date | 2020-05-22 |