| NPI | 1487001434 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: NV PY1041) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: CA PSY28338) |
| 103T00000X Psychologist (Licence: NC 5509) | |
| 103T00000X Psychologist (Licence: WA PY60672946) | |
| Enumeration Date | 2016-05-19 |
| Last Update Date | 2024-05-29 |