| NPI | 1366724361 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: SC 1449) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: RI PS01247) |
| Enumeration Date | 2011-09-15 |
| Last Update Date | 2022-07-21 |