| NPI | 1932204377 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: MA 8580) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist |
| 103TC0700X Psychologist Clinical (Licence: MA 8580) | |
| 103TM1800X Psychologist Mental Retardation & Developmental Disabilities (Licence: MA 8580) | |
| Enumeration Date | 2006-09-13 |
| Last Update Date | 2022-07-21 |