| NPI | 1265883151 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: OR 2970) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: CA 28285) |
| Enumeration Date | 2016-06-22 |
| Last Update Date | 2018-12-27 |