| NPI | 1720131717 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: OR 3191) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: GA 2976) |
| 103G00000X Clinical Neuropsychologist (Licence: OR 3191) | |
| 103TC0700X Psychologist, Clinical (Licence: GA 2976) | |
| Enumeration Date | 2007-01-21 |
| Last Update Date | 2026-07-02 |