| NPI | 1528056736 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: TX 36074) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: TX 36074) |
| 103T00000X Psychologist (Licence: PA PA007810L) | |
| 103T00000X Psychologist (Licence: NJ 35SI00457100) | |
| Enumeration Date | 2005-10-11 |
| Last Update Date | 2023-02-13 |