| NPI | 1316325293 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: WV 81318) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: CO PSY.0004229) |
| 103TC0700X Psychologist, Clinical (Licence: CO PSY.0004229) | |
| Enumeration Date | 2015-05-12 |
| Last Update Date | 2022-04-18 |