| NPI | 1689744336 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: NC 2520) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: NC 2520) |
| 103TC0700X Psychologist, Clinical (Licence: NC 2520) | |
| Enumeration Date | 2006-11-09 |
| Last Update Date | 2020-11-04 |