| NPI | 1134190978 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: AL 1370) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: AL 1370) |
| Enumeration Date | 2006-01-30 |
| Last Update Date | 2020-02-11 |