| NPI | 1063521326 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: AZ 4848) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: GA 001130) |
| 103TC0700X Psychologist, Clinical (Licence: GA 1130) | |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2020-10-05 |