| NPI | 1124684865 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: AZ PSY-005110) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: AZ PSY-005110) |
| 103TC0700X Psychologist, Clinical (Licence: AZ PSY-005110) | |
| Enumeration Date | 2019-05-17 |
| Last Update Date | 2019-05-31 |