| NPI | 1497701916 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: TX 33276) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: LA 1680) |
| 103G00000X Clinical Neuropsychologist (Licence: MA 8527) | |
| Enumeration Date | 2006-05-26 |
| Last Update Date | 2023-09-25 |