| NPI | 1811977325 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TP0016X Psychologist, Prescribing (Medical) (Licence: NM PSY-RXC0074) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: IL 71006364) |
| 103G00000X Clinical Neuropsychologist (Licence: NM 0969) | |
| Enumeration Date | 2006-01-19 |
| Last Update Date | 2021-05-27 |