| NPI | 1528705050 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: IA 110965) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: IA 110965) |
| 103G00000X Clinical Neuropsychologist (Licence: WI 5000-57) | |
| 103T00000X Psychologist (Licence: WI 5000-57) | |
| 103TH0100X Psychologist Health Service (Licence: IA 126559) | |
| Enumeration Date | 2022-05-17 |
| Last Update Date | 2024-09-30 |