| NPI | 1912460247 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: KY 271213) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: KY 271213) |
| Enumeration Date | 2019-04-12 |
| Last Update Date | 2025-06-09 |