| NPI | 1275249559 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: CT 004497) |
| Additional Taxonomies | 103TS0200X Psychologist, School (Licence: CT C112018000208) |
| Enumeration Date | 2023-01-30 |
| Last Update Date | 2023-08-10 |