| NPI | 1538418587 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: MA 10403) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health |
| 103G00000X Clinical Neuropsychologist (Licence: MA 10403) | |
| Enumeration Date | 2012-09-06 |
| Last Update Date | 2021-06-18 |