| NPI | 1306057260 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: CO 2278) |
| Additional Taxonomies | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: CO 2278) |
| 103TC0700X Psychologist, Clinical (Licence: CO 2278) | |
| Enumeration Date | 2007-05-24 |
| Last Update Date | 2022-08-01 |