| NPI | 1366834020 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: TN 3484) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: MI 6301014994) |
| Enumeration Date | 2015-03-04 |
| Last Update Date | 2022-03-29 |