| NPI | 1073030961 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: WI 3815-57) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: KS 2795) |
| Enumeration Date | 2017-08-23 |
| Last Update Date | 2021-02-08 |