| NPI | 1972986750 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: AZ PSY-005802) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: AZ PSY-005802) |
| Enumeration Date | 2015-06-30 |
| Last Update Date | 2026-06-26 |