| NPI | 1689229288 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: KY 273652) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: WV 1227) |
| 103T00000X Psychologist (Licence: WV 1227) | |
| Enumeration Date | 2019-08-09 |
| Last Update Date | 2023-03-06 |