| NPI | 1629091764 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: PA PS003660L) |
| Enumeration Date | 2006-07-26 |
| Last Update Date | 2022-07-21 |