| NPI | 1407467137 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: VT 048.0134234) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: VT 048.0134234) |
| Enumeration Date | 2020-08-14 |
| Last Update Date | 2020-09-09 |