| NPI | 1669800769 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: TN 3221) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health |
| 103TC0700X Psychologist Clinical (Licence: TN 3221) | |
| Enumeration Date | 2013-10-29 |
| Last Update Date | 2020-07-31 |