| NPI | 1821113895 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: ID LCSW-38601) |
| Additional Taxonomies | 246ZE0500X Specialist/Technologist, Other, EEG |
| Enumeration Date | 2007-03-20 |
| Last Update Date | 2025-09-09 |