| NPI | 1144565094 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CO PSY.0004653) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: CO PSY.0004653) |
| Enumeration Date | 2012-12-04 |
| Last Update Date | 2021-07-22 |