| NPI | 1407198229 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: MD 06227) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: FL PY9597) |
| Enumeration Date | 2013-03-19 |
| Last Update Date | 2025-04-29 |