| NPI | 1649091992 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist |
| 103TA0700X Psychologist Adult Development & Aging | |
| 103TB0200X Psychologist Cognitive & Behavioral | |
| 103TC1900X Psychologist Counseling | |
| 103TH0004X Psychologist Health | |
| 103TH0100X Psychologist Health Service | |
| Enumeration Date | 2024-10-21 |
| Last Update Date | 2024-10-21 |