| NPI | 1053373142 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist |
| Additional Taxonomies | 174400000X Specialist (Licence: WV WV612) |
| 174400000X Specialist (Licence: PA PS006251L) | |
| Enumeration Date | 2006-04-04 |
| Last Update Date | 2022-04-12 |