| NPI | 1932144615 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: AZ PSY005163) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist |
| 103TC0700X Psychologist, Clinical (Licence: IN 20041231A) | |
| 103TC0700X Psychologist, Clinical (Licence: IL 071005590) | |
| 103TC0700X Psychologist, Clinical (Licence: MI 6301015915) | |
| Enumeration Date | 2006-06-18 |
| Last Update Date | 2020-02-20 |