| NPI | 1851578512 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: AK 121536) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: WA 60616291) |
| Enumeration Date | 2008-01-24 |
| Last Update Date | 2024-04-24 |