| NPI | 1023176369 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: GA PSY002531) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: GA PSY002531) |
| Enumeration Date | 2006-12-05 |
| Last Update Date | 2021-10-08 |