| NPI | 1598877011 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: VA 0810002709) |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2024-04-11 |