| NPI | 1770905424 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: AK 210447) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: AK 114233) |
| 103G00000X Clinical Neuropsychologist (Licence: AK 210447) | |
| Enumeration Date | 2014-01-15 |
| Last Update Date | 2023-12-13 |