| NPI | 1821475740 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: OR 3323) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: NY 023950) |
| 103G00000X Clinical Neuropsychologist (Licence: OR 3323) | |
| Enumeration Date | 2015-04-29 |
| Last Update Date | 2021-09-02 |