| NPI | 1790839934 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: ND 278) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: ND 278) |
| 103TC0700X Psychologist, Clinical (Licence: ND 278) | |
| Enumeration Date | 2007-01-23 |
| Last Update Date | 2024-01-22 |