| NPI | 1639606775 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: WI 3469) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: WI 3469-57) |
| Enumeration Date | 2017-05-19 |
| Last Update Date | 2024-03-13 |