| NPI | 1568104719 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: ID PSY-203695) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: IN 20043535A) |
| Enumeration Date | 2022-04-08 |
| Last Update Date | 2022-08-19 |