| NPI | 1265153258 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: 213-074) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NJ 213-074) |
| Enumeration Date | 2022-09-07 |
| Last Update Date | 2022-09-07 |