| NPI | 1720558075 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: VA 0810006099) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: VA 0810006099) |
| Enumeration Date | 2018-11-29 |
| Last Update Date | 2024-08-23 |