| NPI | 1629473186 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: CO 5400) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: CO 5400) |
| Enumeration Date | 2014-10-27 |
| Last Update Date | 2024-07-26 |