| NPI | 1760536510 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: LA 254) |
| Additional Taxonomies | 103TC1900X Psychologist Counseling (Licence: LA 254) |
| Enumeration Date | 2007-01-22 |
| Last Update Date | 2021-08-18 |