| NPI | 1508115668 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: VA 0810005975) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist |
| 103T00000X Psychologist (Licence: PA PS017314) | |
| 103TC0700X Psychologist, Clinical (Licence: TN P3385) | |
| Enumeration Date | 2012-09-05 |
| Last Update Date | 2024-10-30 |