| NPI | 1073757761 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: MO 2016024854) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: KS 2422) |
| Enumeration Date | 2009-04-24 |
| Last Update Date | 2026-03-26 |