| NPI | 1568925626 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: AR 202114) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: AR 202114) |
| Enumeration Date | 2019-04-07 |
| Last Update Date | 2022-09-06 |