NPI | 1366783250 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: NV PY1275) |
Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: AZ PSY-005734) |
222Q00000X Developmental Therapist | |
Enumeration Date | 2013-03-03 |
Last Update Date | 2025-08-13 |