| NPI | 1801425491 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: FL PY11800) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: FL PY11800) |
| Enumeration Date | 2020-04-06 |
| Last Update Date | 2023-09-11 |