| NPI | 1093995219 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: AK PSYP539) |
| Additional Taxonomies | 174400000X Specialist (Licence: AK 539) |
| 261QM2500X Clinic/Center, Medical Specialty (Licence: AK PsyP539) | |
| Enumeration Date | 2007-11-05 |
| Last Update Date | 2024-04-12 |