| NPI | 1841923166 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: UT 13132504-2501) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: MI 6301019002) |
| Enumeration Date | 2022-07-05 |
| Last Update Date | 2023-08-23 |