| NPI | 1790058899 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: VA 0810004544) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: VA 0810004544) |
| 103TF0200X Psychologist, Forensic (Licence: VA 0810004544) | |
| 103TH0004X Psychologist, Health (Licence: 0810004544) | |
| Enumeration Date | 2012-02-20 |
| Last Update Date | 2025-07-18 |