| NPI | 1083963169 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist |
| Additional Taxonomies | 2084N0600X (Licence: PA PS018519) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2012-09-05 |
| Last Update Date | 2025-05-09 |