| NPI | 1255904819 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: FL PY11054) |
| Enumeration Date | 2021-07-21 |
| Last Update Date | 2021-07-21 |