| NPI | 1386702397 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: UT 10601911-2501) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: NY 020581) |
| Enumeration Date | 2006-12-04 |
| Last Update Date | 2026-01-30 |