| NPI | 1790524908 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TF0200X Psychologist, Forensic (Licence: FL 5986) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: VT 048.0134268) |
| Enumeration Date | 2024-05-20 |
| Last Update Date | 2024-05-20 |