| NPI | 1295720969 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: OR 3589) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: IA 00973) |
| 103G00000X Clinical Neuropsychologist (Licence: UT 7381301-2501) | |
| 103T00000X Psychologist (Licence: IA 00973) | |
| Enumeration Date | 2005-09-19 |
| Last Update Date | 2022-09-26 |