| NPI | 1194139550 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: LA 1372) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: MD 05235) |
| 103TC0700X Psychologist, Clinical (Licence: MD 05235) | |
| Enumeration Date | 2014-06-13 |
| Last Update Date | 2016-09-28 |