| NPI | 1518453406 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: MA PSY10000181) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: UT 10326005-2501) |
| Enumeration Date | 2018-07-03 |
| Last Update Date | 2023-08-24 |