| NPI | 1457830317 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: VA 009335804I) |
| Additional Taxonomies | 103TP0814X Psychologist, Psychoanalysis (Licence: VA 009335804I) |
| 171000000X Military Health Care Provider | |
| 174H00000X Health Educator (Licence: DC NIH-USA) | |
| 103G00000X Clinical Neuropsychologist (Licence: GA BH23885) | |
| 103T00000X Psychologist | |
| 103T00000X Psychologist | |
| Enumeration Date | 2018-08-11 |
| Last Update Date | 2020-03-26 |