| NPI | 1356677611 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: NC 3865) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: NC 3865) |
| Enumeration Date | 2009-10-21 |
| Last Update Date | 2021-04-26 |