| NPI | 1750699070 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: CT 003313) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: CT 003313) |
| 103TB0200X Psychologist Cognitive & Behavioral (Licence: KS 1364) | |
| Enumeration Date | 2010-09-21 |
| Last Update Date | 2024-06-07 |