| NPI | 1194213140 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: GA PSY00413) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: GA PSY004173) |
| Enumeration Date | 2018-04-25 |
| Last Update Date | 2020-04-29 |