| NPI | 1538823125 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: MD 07472) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: MD 07472) |
| Enumeration Date | 2021-10-28 |
| Last Update Date | 2026-05-10 |