| NPI | 1386114064 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: AZ PSY-005047) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: AZ PSY-005047) |
| Enumeration Date | 2018-11-26 |
| Last Update Date | 2024-05-01 |