| NPI | 1700553823 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist |
| Additional Taxonomies | 103TH0100X Psychologist, Health Service |
| 103TP2701X Psychologist, Group Psychotherapy | |
| Enumeration Date | 2021-08-26 |
| Last Update Date | 2023-08-30 |