| NPI | 1295288967 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: NV PY0879) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2016-07-29 |
| Last Update Date | 2020-03-23 |