| NPI | 1679029169 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: AK 144539) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist |
| Enumeration Date | 2016-08-25 |
| Last Update Date | 2024-09-06 |