| NPI | 1801343835 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: TN 3576) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: GA PSY004610) |
| Enumeration Date | 2016-09-07 |
| Last Update Date | 2023-07-07 |