| NPI | 1487904587 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: CT 003640) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: RI Ps483) |
| Enumeration Date | 2012-09-16 |
| Last Update Date | 2022-03-31 |