| NPI | 1104870146 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: PA OS004234L) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: PA PS004113L) |
| Enumeration Date | 2006-05-22 |
| Last Update Date | 2026-04-28 |