| NPI | 1659488583 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: AZ 3376) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: AZ 3376) |
| 103TA0700X Psychologist, Adult Development & Aging (Licence: AZ 3376) | |
| Enumeration Date | 2006-08-24 |
| Last Update Date | 2025-09-11 |