| NPI | 1427110600 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: MT 368) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: CA 20234) |
| 103G00000X Clinical Neuropsychologist (Licence: CO 2902) | |
| Enumeration Date | 2006-12-14 |
| Last Update Date | 2021-07-29 |