| NPI | 1992702153 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: AZ PSY-004934) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: AZ PSY-004934) |
| Enumeration Date | 2005-07-02 |
| Last Update Date | 2018-09-24 |