| NPI | 1386923480 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: WV 1024) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: WV 1024) |
| Enumeration Date | 2011-08-08 |
| Last Update Date | 2021-01-22 |