| NPI | 1366783250 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: AZ 5734) |
| 222Q00000X Developmental Therapist | |
| Enumeration Date | 2013-03-03 |
| Last Update Date | 2024-10-16 |