| NPI | 1295925386 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: AZ 3232) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: AZ 3232) |
| 103TF0200X Psychologist, Forensic (Licence: AZ 3232) | |
| Enumeration Date | 2007-07-26 |
| Last Update Date | 2020-07-06 |