| NPI | 1780961177 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: NC 4178) |
| 103TC1900X Psychologist, Counseling | |
| Enumeration Date | 2011-11-14 |
| Last Update Date | 2020-03-02 |