| NPI | 1699861278 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: SC 384) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: DC PSY1000980) |
| 103T00000X Psychologist (Licence: SC 384) | |
| 103TC0700X Psychologist Clinical (Licence: DC PSY1000980) | |
| Enumeration Date | 2006-10-04 |
| Last Update Date | 2023-01-05 |