| NPI | 1538412382 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: ID PSY - 202728) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: ID PSY - 202728) |
| Enumeration Date | 2012-10-17 |
| Last Update Date | 2024-05-18 |