| NPI | 1790311157 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: ID PSY-203778) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: WA PY61070460) |
| 103TC0700X Psychologist, Clinical (Licence: MI 6301018219) | |
| 103TC0700X Psychologist, Clinical (Licence: WA PY61070460) | |
| Enumeration Date | 2020-03-18 |
| Last Update Date | 2023-03-29 |