| NPI | 1073358651 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: TN 4092) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: IA 125290) |
| Enumeration Date | 2024-06-26 |
| Last Update Date | 2024-11-26 |