| NPI | 1922480755 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MD 04643) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: MD 04643) |
| Enumeration Date | 2015-06-29 |
| Last Update Date | 2024-03-15 |