| NPI | 1942998679 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist |
| Additional Taxonomies | 103TR0400X Psychologist, Rehabilitation |
| 103TC2200X Psychologist, Clinical Child & Adolescent | |
| Enumeration Date | 2023-05-01 |
| Last Update Date | 2025-09-09 |