| NPI | 1437393170 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: KY 2010-89) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: TN 2859) |
| Enumeration Date | 2009-04-24 |
| Last Update Date | 2022-11-17 |