| NPI | 1396203956 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: FL PY11209) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: FL PY11209) |
| 103T00000X Psychologist (Licence: TX 41032) | |
| Enumeration Date | 2019-03-03 |
| Last Update Date | 2026-08-20 |