| NPI | 1760823348 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: TN P0000003586) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: TN 3586) |
| 103TC0700X Psychologist Clinical (Licence: CO PSY.0004288) | |
| Enumeration Date | 2013-07-11 |
| Last Update Date | 2022-09-27 |