| NPI | 1053048736 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: CO PSY.0005932) |
| Additional Taxonomies | 103T00000X Psychologist |
| Enumeration Date | 2022-08-03 |
| Last Update Date | 2022-10-17 |