| NPI | 1518439397 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: VA 0810006204) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: CO PSY.0004960) |
| Enumeration Date | 2018-12-18 |
| Last Update Date | 2021-10-26 |