| NPI | 1548717044 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: VA 0810005992) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: VA 0810005992) |
| Enumeration Date | 2016-09-01 |
| Last Update Date | 2023-06-26 |