| NPI | 1396764692 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: CT 3141) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: MA 8264) |
| Enumeration Date | 2006-07-18 |
| Last Update Date | 2025-09-03 |